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]
For people under 18 who are pregnant or have recently been pregnant and have suspected sepsis of any cause, consult local guidelines for choice of antibiotic. [2016, amended 2024]
For people aged 18 or over who are or have recently been pregnant and 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]
If people up to 16 years who are or have recently been pregnant 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. 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]
If people aged 16 or over who are or have recently been pregnant need intravenous fluid resuscitation, use crystalloids that contain sodium in the range 130 to 154 mmol/litre with a bolus of 500 ml over less than 15 minutes. [This recommendation is from NICE's guideline on intravenous fluid therapy in adults in hospital.] [2017]
If using a pump or flow controller to deliver intravenous fluids for resuscitation to people over 12 years with suspected sepsis who are or have recently been pregnant and need fluids in bolus form, ensure the device is capable of delivering fluid at the required rate, for example at least 2000 ml/hour in adults. [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 1.7.9). [2016, amended 2024]
Give oxygen to achieve a target saturation of 94 to 98% for people aged 18 or over who are or have recently been pregnant, or 88 to 92% for those at risk of hypercapnic respiratory failure. [2016]
Oxygen should be given to people under 18 with suspected sepsis who are or have recently been pregnant and have signs of shock or oxygen saturation (SpO2) of less than 92% when breathing air. Treatment with oxygen should also be considered for people under 18 who are or have recently been pregnant and have an SpO2 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.