Intended for healthcare professionals


Will new sepsis guidance prompt a surge in unnecessary use of antibiotics?

BMJ 2016; 354 doi: (Published 07 September 2016) Cite this as: BMJ 2016;354:i4209
  1. Ingrid Torjesen, freelance journalist, London, UK
  1. ingrid_torjesen{at}

A series of patients dying unnecessarily from sepsis has increased public pressure on doctors to get better at spotting it. But some are concerned that NICE guidance may lead to many patients being given antibiotics “just in case.” Ingrid Torjesen reports

In July the National Institute for Health and Care Excellence (NICE) published its first guidance on recognising, assessing, and diagnosing sepsis.1 The guidance emphasises that health professionals must think about the possibility of sepsis in all patients who may have an infection and treat those who show signs of sepsis with the same urgency given to those who complain of chest pain that might be a heart attack.2

In hospitals, patients with suspected sepsis who meet at least one of several high risk criteria (box) should have blood tests, and if sepsis is not excluded in one hour they should be given a broad spectrum antibiotic at the maximum recommended dose.

NICE criteria for high risk of sepsis

  • Altered mental state

  • Raised respiratory rate or new need for oxygen

  • Raised heart rate

  • Low blood pressure

  • Urinary retention for 18 hours

  • Mottled or ashen appearance

But some microbiologists and emergency medicine doctors warn that the guidance will increase the number of patients who may now be considered at high risk and could therefore prompt a big rise in unnecessary antibiotic prescribing at a time when huge efforts are being made to reduce prescribing and curb growing antimicrobial resistance. They also warn that prescribing antibiotics to seriously ill patients who turn out not to have sepsis could adversely affect their care.

The guideline is “incredibly complicated and thorough,” says Stephen Brett, consultant in intensive care medicine and head of research for critical care at Imperial College Healthcare NHS Trust, but “it is unclear how it will be delivered practically” on the front line.

“There are certainly …

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