Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

sepsis of unknown cause

1st line – admission to intensive care unit (ICU), empirical antimicrobial therapy, and supportive therapy

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INITIAL
|
sepsis of unknown cause
1st line – 

admission to intensive care unit (ICU), empirical antimicrobial therapy, and supportive therapy

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[43]

Empirical antimicrobial therapy of sepsis is appropriate until the diagnosis of HCPS is made. Local protocols and guidelines should be followed.

Once the diagnosis is made, antibiotics should be discontinued.

Analgesia and antipyretics are given while awaiting confirmation of diagnosis.

ACUTE

confirmed hantavirus infection

1st line – cessation of antibiotic therapy

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ACUTE
|
confirmed hantavirus infection
1st line – 

cessation of antibiotic therapy

Antibiotics are discontinued once diagnosis of hantavirus infection is made and treatment is supportive care thereafter.

Plus – supportive care

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ACUTE
|
confirmed hantavirus infection
Plus – 

supportive care

Treatment recommended for ALL patients in selected patient group

Supplemental oxygen and intubation for respiratory support may be required. About 40% of patients admitted to hospital will not require intubation and can be managed with supplemental oxygen and careful fluid administration.[5] Intubated survivors can usually be extubated within 1 week.[5]

Fluids should be given cautiously so as not to accelerate the development of pulmonary oedema.

Inotropic therapy may be required for cardiogenic shock. Dobutamine plus noradrenaline (norepinephrine) has been suggested as an effective regimen.[46] Dose should be started low and titrated according to response.

Primary options

dobutamine: 5-15 micrograms/kg/minute intravenously

and

noradrenaline (norepinephrine): 1-30 micrograms/minute intravenously

Consider – extracorporeal membrane oxygenation (ECMO)

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ACUTE
|
confirmed hantavirus infection
Consider – 

extracorporeal membrane oxygenation (ECMO)

Additional treatment recommended for SOME patients in selected patient group

A falling cardiac index with evidence of cardiovascular collapse is an indication for ECMO support.[46]

Studies suggest that up to 72% of hantavirus cardiopulmonary syndrome (HCPS) patients with high mortality risk supported with ECMO have survived to hospital discharge.[46][62]

Features indicating high mortality risk include: a cardiac index <2.5 L/minute/m²; serum lactate >4 mmol/L; cardiac arrhythmia (ventricular fibrillation, tachycardia, or pulseless electrical dissociation); shock refractory to fluids; and vasoactive therapy.[61]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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