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.
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 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]
Treat babies presenting in hospital with suspected sepsis in their first 72 hours after birth with intravenous benzylpenicillin and gentamicin. [2016]
Treat newborn babies under 28 days who present with community acquired sepsis with ceftriaxone 50 mg/kg once daily if they are:
more than 40 weeks corrected gestational age
not already receiving an intravenous calcium infusion at the time.
If 40 weeks corrected gestational age or below or receiving an intravenous calcium infusion, use cefotaxime 50 mg/kg every 6 to 12 hours, depending on the age of the baby. [2016]
For babies younger than 3 months, give an additional antibiotic active against listeria (for example, ampicillin or amoxicillin). [2016]
For people under 16 (excluding newborn babies under 28 days) 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. For newborn babies under 28 days, see recommendation 1.8.6. [2016, amended 2024]
For people under 16 (excluding newborn babies under 28 days) 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. For newborn babies under 28 days, see recommendation 1.8.5. [2016, amended 2024]
If newborn babies under 28 days need intravenous fluid resuscitation, use glucose-free crystalloids that contain sodium in the range 130 to 154 mmol/litre, with a bolus of 10 to 20 ml/kg over less than 10 minutes. [This recommendation is from NICE's guideline on intravenous fluid therapy in children and young people in hospital.] [2017]
If people under 16 need intravenous fluid resuscitation, use glucose-free crystalloids that contain sodium in the range 130 to 154 mmol/litre, with a bolus of 10 ml/kg over less than 10 minutes, up to a maximum bolus volume of 250 ml. Take into account pre-existing conditions (for example, cardiac disease or kidney disease), because smaller fluid volumes may be needed. [This recommendation is from NICE's guideline on intravenous fluid therapy in children and young people in hospital.] [2017]
Use a pump, or syringe if no pump is available, to deliver intravenous fluids for resuscitation to children under 12 with suspected sepsis who need fluids in bolus form. [2016]
If using a pump or flow controller to deliver intravenous fluids for resuscitation to young people aged 12 to 15 with suspected sepsis who need fluids in bolus form, ensure the device is capable of delivering fluid at the required rate. [2016]
Reassess the person after completion of the intravenous fluid bolus, and if there is no improvement give a second bolus. If there is no improvement after a second bolus, alert a consultant to attend in person (in line with recommendation 1.7.11). [2016, amended 2024]
Oxygen should be given to people under 16 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 under 16s 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.