How to optimise duration of antibiotic treatment in patients with sepsis?
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4357 (Published 23 November 2020) Cite this as: BMJ 2020;371:m4357
- TP Hellyer, NIHR clinical lecturer in intensive care medicine1,
- T Mantle, foundation year 1 doctor2,
- R McMullan, NHS consultant medical microbiologist3,
- P Dark, professor of critical care medicine, NHS consultant45
- 1Newcastle University, Newcastle, UK
- 2Manchester Medical School, Manchester, UK
- 3Belfast Health & Social Care Trust and Reader, Centre for Experimental Medicine, Queen’s University Belfast, Belfast, UK
- 4Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
- 5Northern Care Alliance NHS Group, Greater Manchester, UK
- Correspondence to paul.m.dark{at}manchester.ac.uk
What you need to know
Guidelines recommend 7 to 10 days of antibiotic treatment for patients with sepsis, but a shorter duration may be safe in certain individuals
Low quality evidence suggests that monitoring biomarkers such as procalcitonin can reduce antibiotic duration in sepsis by about one day, but the effectiveness in severe disease and in low resource settings is not known
Use your clinical judgement to consider the diagnostic evidence, signs of resolution or worsening of infection, and individual risk when making a decision about the choice and duration of antibiotic treatment
Sepsis occurs when the body’s response to infection is imbalanced. It can result in life threatening organ dysfunction.1 About 49 million patients had sepsis worldwide in 2017 and 11 million people died of the condition.2 Among those hospitalised with sepsis, 17% die in hospital and a further 15% die within a year of hospital discharge.34
Antibiotics represent the cornerstone of treatment. The Surviving Sepsis Campaign (SSC) consensus guidelines recommend treatment for 7 to 10 days, but this is a weak recommendation.5 Use of antibiotics risks the emergence of antimicrobial resistance and antibiotic-associated infections, such as Clostridiodes difficile. Patients may suffer from toxic effects of the drugs.6 Balancing the need to treat severe infections effectively against the risks of overuse of antibiotics is central to the principle of antibiotic stewardship. For severe covid-19, antibiotic stewardship remains important for critically ill patients with pneumonitis and sepsis who are commonly treated with broad spectrum antibiotics.7 Antibiotic overuse in sepsis results in substantial risk of acquiring difficult-to-treat infections, with further risk of sepsis and poor patient outcomes.5
The optimum duration of antibiotic treatment for patients with sepsis is uncertain. A biomarker-guided approach—for example, using serial measurements of procalcitonin to determine optimal duration of antibiotics—has been studied. Trials …
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