Should antibiotics for sepsis be given in the ambulance?

Observational studies of patients in sepsis strongly suggest that outcomes are improved by giving antibiotics as soon as possible after recognition of sepsis. The Surviving Sepsis Campaign recently decided everyone with suspected sepsis should receive antibiotics within one hour of emergency department arrival.

So why not give antibiotics before the patient even arrives to the hospital?

Researchers in the Netherlands randomized 2,700 patients at multiple centers whom EMS found to have fevers or hypothermia, along with tachycardia or tachypnea (i.e., SIRS), to receive ceftriaxone (2 grams administered IV by EMS) on the way to the hospital, or usual care. All patients received oxygen and IV fluids. EMS personnel received some additional training on sepsis recognition prior to the study.

Antibiotics were provided more than 90 minutes earlier (median) to patients in the prehospital group. Yet both groups had statistically equivalent 28-day mortality of 8%. There were also no differences in length of stay in the ICU or hospital. Slightly fewer patients who got antibiotics in the ambulance were re-admitted to the hospital within 28 days.

Patients randomized to usual care still got antibiotics quickly: about 70 minutes after arrival to the hospital. Poorer outcomes observed in previous studies generally fell on patients whose antibiotics were delayed by hours.

Source: Lancet Respir Med