The Cribsiders S6 Ep130: It’s a Bundle: Pediatric Sepsis and the New Phoenix Criteria (Part 2)
Jan 23, 2025
Dr. Chris Horvat, a pediatric sepsis expert from Pittsburgh, dives into the complexities of diagnosing and treating pediatric sepsis. He discusses the urgency of timely antibiotic administration and the nuances of fluid resuscitation strategies. The conversation also touches on the controversial role of vitamin C in treatment and explores emerging therapies like corticosteroids. Horvat emphasizes the use of the innovative Phoenix criteria to track patient progress and the need to address health disparities, particularly among non-English-speaking families.
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Early Antibiotic Strategy
- Start broad-spectrum antibiotics early when concerned about pediatric sepsis.
- For suspected MRSA pneumonia, consider double coverage with vancomycin plus clindamycin or doxycycline.
Timing of Antibiotics
- Administer antibiotics as soon as possible, ideally within three hours for pediatric sepsis.
- Understand sicker patients often get antibiotics sooner but have worse outcomes, reflecting illness severity rather than treatment delay.
Fluid Resuscitation Approach
- Use isotonic crystalloid fluids like Plasmalyte or lactated ringers for initial pediatric sepsis resuscitation.
- Bolus 20 mL/kg and reassess frequently for signs of fluid overload before giving more.