Choose the infection. Check the risk. Review the options.
Use direct organ-dysfunction assessment for rapid review, or open the full SOFA / ABG screener.
Infection and suspected source
Sepsis assessment
Acute organ dysfunction attributable to suspected infection?
Select organ dysfunction status to continue.
Complete SOFA for a structured assessment; enter ABG/lactate where available. You can still make a clinical severity determination if measurements are incomplete.
Infection + acute organ dysfunction
Conventional SOFA score (0–24). Enter observed values for the same clinical assessment. Suspected/confirmed infection is taken from the Evidence of infection field above. Missing values are not assumed normal. [8,9]
ABG and serial lactate
PaO₂ and FiO₂ calculate the respiratory SOFA component. Acid–base variables and lactate are clinical adjuncts and do not add SOFA points. Use a contemporaneous arterial sample for PaO₂; lactate can also be measured from venous blood. [9,10]
Sepsis-3 septic shock criteria require sepsis + vasopressor requirement to maintain MAP ≥65 mmHg + lactate >2 mmol/L despite adequate volume resuscitation. The two confirmation fields above are independent clinical assessments, not automatically inferred from SOFA drugs or MAP. Lactate is nonspecific; interpret changes alongside clinical perfusion and do not give additional fluid solely to normalize it. [9,10]
Sepsis-3 screening requires suspected/confirmed infection plus an acute SOFA increase ≥2 points attributable to infection. A current SOFA ≥2 alone is insufficient without baseline assessment. SOFA does not diagnose septic shock; shock also requires clinical assessment including vasopressor and lactate criteria. The legacy SOFA calculation is distinct from SOFA-2.
SOFA inputs are adjuncts. A positive screening calculation can populate the clinical severity field; review and confirm before generating a regimen.
Factors that change the choice
Common and syndrome-specific factors appear first. Open the remaining checklist only when relevant.
Other patient and microbiology factors
Age, weight and renal dosing parameters (optional)
Culture / MIC details (optional)
Document the organism, specimen, individual AST/MIC, and source. Do not infer NDM from generic carbapenem resistance.
Supportive treatment instructions
Parallel tasks (first hour to first six hours bundle)
- Send cultures before first dose if feasible: blood ×2, sputum/ETA/NDBAL, urine, pus/drain.
- Source control within 6–12 h (drain/debride, remove/exchange infected lines & tubes).
- Hemodynamics: PLR and POCUS-guided balanced crystalloids (RL); noradrenaline infusion to MAP ≥65 mmHg; hydrocortisone 4 mg/kg IV bolus and 4 mg/kg IVI over 24 h for 3 days.
- Oxygenation target: PaO2 70 - 90 mmHg, SpO₂ 92–96%; avoid hyperoxia (avoid PaO2 > 120 mmHg for prolonged periods).
- Intubate and Ventilate if, GCS≤8 or inability to protect airway, or, Refractory Hypoxemia (PaO2/FiO2 <200 or SpO2 <90% on FiO2 >50% on >30 LPM flow on HFNC), or, Hypercapnic Respiratory Failure (PaCO2 ≥50 mmHg with pH <7.30), or, Signs of Impending Exhaustion (RR>33 bpm, tracheal tug, sweating, agitation, paradoxical breathing).
- Monitoring: mental status, capillary refill time, ABG, lactate trend, MAP, urine output, tympanic and peripheral temperature, 6am blood glucose, serum NT-proBNP, serum creatinine, INR; daily de-escalation review (24–48–72 h).
- Glycemia 140–180 mg/dL.
- Stress-ulcer prophylaxis - pantoprazole 40 mg IV/PO once daily.
- VTE prophylaxis, Enoxaparin 20 - 40 mg SC once daily (withhold if platelets < 80,000/micro L, or INR > 1.4).
- Early enteral nutrition, calorie dense diet / NGT formula feed (2 - 3 scoops/100mL), plus MCT oil 20 mL twice daily.
- Severe anemia correction, target Hb 8 - 10 g/dL; followup action, syrup multivitamin 15 mL once daily.
- Communicate with the family - present physical status, prognosis, ongoing treatment, short term treatment plan.
Adult antibiotic dosing reference
Adult reference dosing — not an automatic prescription
Typical adult doses shown assume normal or stable renal/hepatic function unless noted. In shock, AKI, obesity, ARC, IHD or CRRT, verify loading dose, maintenance dosing, infusion strategy, dialyzer/effluent, levels and local pharmacy protocol. Differing syndrome-specific doses are intentional.
| Agent | Normal renal function reference | High-risk caveat / reference |
|---|
References
References
- National Centre for Disease Control; Indian Council of Medical Research. National treatment guidelines for antimicrobial use in infectious disease syndromes. Version 2.0. New Delhi: Ministry of Health and Family Welfare, Government of India; 2025 Nov.
- Jawaharlal Institute of Postgraduate Medical Education and Research, Antimicrobial Stewardship Committee. Antibiotic policy 2026. Version 1.0. Puducherry: JIPMER; 2026 Apr 15.
- Tamma PD, Bonomo RA, Heil EL, Justo JA, Satlin MJ, Mathers AJ. Infectious Diseases Society of America 2026 guidance on the treatment of antimicrobial-resistant Gram-negative infections. Clin Infect Dis. 2026 Aug 8:ciag481. doi: 10.1093/cid/ciag481.
- Todi SK, Jagiasi BG, Juneja D, Gopaldas JA, Soni KD, Karanth S, et al. Indian Society of Critical Care Medicine guidelines on evidence-based recommendations for the treatment of carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and carbapenem-resistant Pseudomonas aeruginosa in critically ill patients: a GRADE-guided approach. Indian J Crit Care Med. 2026;30(6):472–517. doi: 10.5005/jp-journals-10071-25216.
- Stanford Health Care, Antimicrobial Safety & Sustainability Program. SHC sepsis empiric antibiotic selection guide. Stanford (CA): Stanford Health Care; 2026 Aug.
- Stanford Health Care, Antimicrobial Stewardship Program. Stanford Health Care antimicrobial dosing reference guide. Stanford (CA): Stanford Health Care; 2026 Aug.
- Stanford Health Care, Clinical Microbiology Laboratory. SHC antibiogram data for bacterial and yeast isolates, January 1–December 31, 2025 [institutional surveillance report]. Stanford (CA): Stanford Health Care; publication date not stated.
- Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707–710. doi: 10.1007/BF01709751.
- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287.
- Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med. 2026. doi: 10.1097/CCM.0000000000007075.
Software licence and clinical-use limitation
BEAT-C original © 2025 Prof. Jyotirmay Kirtania, distributed under GNU GPL v3 or later. This modified version is a decision-support reference, not a validated diagnostic or prescribing medical device. It runs locally; does not transmit patient data. No warranty. The prescribing clinician remains responsible for patient-specific decisions, verification and local governance approval before clinical use.