Pedemy All toolsAnswer one question at a time. The plan at the bottom gives fluids, antibiotics and vasoactives with weight-based doses. Tap any earlier answer to change it.
This pathway supports clinicians in the first hours of managing pediatric sepsis and septic shock at any age. It asks a short series of questions and produces a plan for fluids, antibiotics and vasoactive drugs with weight-based doses.
It first separates septic shock from sepsis without shock. Shock is suspected infection with hypotension, or two or more signs such as altered mental status, capillary refill over 3 seconds, cold or mottled skin, weak pulses, lactate over 2 mmol/L or low urine output. Age under 1 month changes antibiotic choice to ampicillin, ceftazidime and acyclovir. In older children, the likely source — community-acquired, immunocompromised or line-related, intra-abdominal, or toxic shock — selects regimens such as ceftriaxone with vancomycin, cefepime, piperacillin–tazobactam, or added clindamycin. In shock, 10 to 20 mL/kg crystalloid boluses up to 40 to 60 mL/kg are given in the first hour, and persistent shock after that leads to an epinephrine infusion.
The plan sets antibiotic timing within 1 hour for shock and within 3 hours without shock, plus cultures and disposition. It is based on the Surviving Sepsis Campaign international guidelines for children (2020), with antibiotic doses from the AAP Red Book (2024–2027).
The pathway gives balanced crystalloid boluses of 10–20 mL/kg, up to 40–60 mL/kg in the first hour, reassessing after each bolus. Stop for crackles, hepatomegaly or worsening oxygenation.
Give antibiotics within 1 hour in septic shock and within 3 hours in sepsis without shock. Take a blood culture first, but never delay antibiotics to get it.
An epinephrine infusion at 0.05–0.3 mcg/kg/min is first-line, and a peripheral line is acceptable until central access. Norepinephrine is an alternative or add-on in warm shock, and hydrocortisone is reserved for shock refractory to fluids and vasoactives.
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