People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Healthcare professionals should follow our general guidelines for people delivering care:
When the source of infection is confirmed or microbiological results are available:
review the choice of antibiotic(s) and
change the antibiotic(s) according to results, using a narrower-spectrum antibiotic, if appropriate. [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on managing suspected sepsis: type and timing of antibiotics.
Full details of the evidence and the committee's discussion are in evidence review B: managing and treating suspected sepsis in acute hospital settings; antibiotic treatment in people with suspected sepsis.
For all people with suspected sepsis and a clear source of infection, use existing local antimicrobial guidance. [2016]
For guidance on antibiotics for meningococcal disease, see the NICE guideline on bacterial meningitis and meningococcal disease:
outside of hospital, see the section on transfer to hospital and antibiotics before arrival at hospital
in hospital, see the section on antibiotics for meningococcal disease in hospital. [2016, amended 2025]
Follow the recommendations in NICE's guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use when prescribing and using antibiotics to treat people with suspected or confirmed sepsis. [2016]
For people aged 16 to 18 with suspected community acquired sepsis of any cause, give ceftriaxone 80 mg/kg once a day with a maximum dose of 4 g daily at any age. [2016, amended 2024]
For people aged 16 to 18 with suspected sepsis who are already in hospital, or who are known to have previously been infected with or colonised with ceftriaxone-resistant bacteria, consult local guidelines for choice of antibiotic. [2016, amended 2024]
For people aged 18 years or over who need an empirical intravenous antimicrobial for suspected sepsis but who have no confirmed diagnosis, use an intravenous antimicrobial from the agreed local formulary and in line with local (where available) or national guidelines. [2016]
Give oxygen to achieve a target saturation of 94% to 98% for people aged 18 years or over or 88% to 92% for those at risk of hypercapnic respiratory failure. [2016]
Oxygen should be given to people aged 16 to 18 with suspected sepsis who have signs of shock or oxygen saturation (SpO2) of less than 92% when breathing air. Treatment with oxygen should also be considered for children with an SpO2 of greater than 92%, as clinically indicated. [2016]
Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.