Antibiotic therapy, intravenous fluid and oxygen

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1.14 Choice of antibiotic therapy for people with suspected sepsis



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]

Newborn babies under 28 days


Treat newborn babies under 28 days presenting in hospital with suspected sepsis in their first 72 hours with intravenous benzylpenicillin and gentamicin. [2016]


Treat newborn babies under 28 days who are more than 40 weeks corrected gestational age who present with community acquired sepsis with ceftriaxone 50 mg/kg unless 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]

Under 3 months old


For children younger than 3 months, give an additional antibiotic active against listeria (for example, ampicillin or amoxicillin). [2016]

Under 18s excluding newborn babies


For people under 18 years (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 1.14.6. [2016, amended 2024]


For people under 18 years (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 1.14.5. [2016, amended 2024]

People aged 18 or over


For people aged 18 years and 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]

1.15 Intravenous fluids for people with suspected sepsis

Type of fluid


If people up to 16 years 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]


Consider human albumin solution 4 to 5% for fluid resuscitation only in patients with sepsis and shock. [2016]


Do not use starch-based solutions or hydroxyethyl starches for fluid resuscitation for people with sepsis. [2016]

Mode of delivery


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 people over 12 years with suspected sepsis who need fluids in bolus form ensure device is capable of delivering fluid at required rate for example at least 2000 ml/hour in adults. [2016]

When to deliver a second bolus


Reassess the patient after completion of the intravenous fluid bolus, and if no improvement give a second bolus. If there is no improvement after a second bolus:

  • for people under 16 and people who are or have recently been pregnant, alert a consultant to attend in person (in line with recommendation 1.7.11 and recommendation 1.10.9)

  • for people over 16 who are not pregnant or have not recently been pregnant, ensure the senior clinical decision maker attends in person (in line with recommendation 1.13.7). [2016, amended 2024]

1.16 Using oxygen for people with suspected sepsis


Give oxygen to achieve a target saturation of 94−98% for people aged 18 years and over or 88−92% for those at risk of hypercapnic respiratory failure. [2016]


Oxygen should be given to people under 18 years 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. See recommendation 1.4.10 for safety warnings about the use of pulse oximeters. [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.

  • National Institute for Health and Care Excellence (NICE)