Use of antibiotics in the ambulance for sepsis patients: is earlier really better?

Bolliger, Rebekka; Merker, Meret; Schuetz, Philipp

doi:10.21037/jtd.2018.02.49

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…We agree with the commentators that training of EMS personnel is important (1,2) and that the development and implementation of educational programs for the recognition and treatment of sepsis, should be a priority (1). A study which was conducted in the Netherlands, prior to the start of the PHANTASi trial, found an in-hospital mortality rate of 21% for septic patients who were transported by EMS (7), which was higher than the in-hospital mortality rate of 6% in the PHANTASi trial.…”

supporting

confidence: 67%

“…These patients often receive antibiotics despite having a viral infection. This also highlights the importance of training medical personnel in the recognition of sepsis, as well as the added value of developing and/or validating sepsis biomarkers, as already pointed out by both commentators (1,2).…”

mentioning

confidence: 61%

“…We read, with interest, the letters to editor by Rello et al (1) and Bolliger et al (2) in response to our Prehospital Antibiotics Against Sepsis (PHANTASi) trial which was recently published in the Lancet Respiratory Medicine (3).…”

mentioning

confidence: 99%

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Author’s response to commentary on the PHANTASi trial

et al. 2018

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supporting

confidence: 67%

mentioning

confidence: 61%

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Author’s response to commentary on the PHANTASi trial

et al. 2018

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“…Whilst assessed as being at low risk of bias and being appropriately powered to detect a difference in mortality at 90 days if such a difference existed, it has received criticism for several perceived weaknesses. 37 Alam's study population would best be described as being less seriously ill; only 4% of all enrolled patients were classified as severe, that being having ‘septic shock’, limiting the generalisability of the results to a broader population outside the auspices of a clinical trial whom may more commonly have a more severe illness. Further, 75% of the enrolled patients were referred to the ambulance service by general practitioners (GP) and 25% of those were already receiving antibiotics; this decreases the generalisability to an ambulance service emergency response context which would be more likely to see patients who have called for assistance themselves and who are not already on antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – a systematic review

Poynter,

Farrugia,

Kelly

et al. 2023

Paramedicine

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Sepsis is an increasingly common presentation to which ambulance resources are dispatched. Whilst early administration of antibiotics (AB) has been associated with improved outcomes, the impact of prehospital administration in an ambulance service context appears uncertain. This systematic review aimed to compare the effect of prehospital administration of antibiotics together with usual care (oxygen and intravenous fluids), to usual care alone, on mortality for patients with sepsis. A systematic review was conducted adherent to JBI methodology. Studies were eligible for inclusion if they were published after 2000; conducted in the prehospital setting; compared AB plus usual care to usual care alone in the prehospital phase; and reported an outcome of mortality at any time point. Systematic searches of Medline, CINAHL, EMBASE and Google Scholar were conducted, with included articles subjected to quality assessment using JBI appraisal tools. Each stage was completed by two authors, with a third engaged to resolve conflicts. A narrative synthesis was conducted and reported, and certainty of evidence was assessed. Of 587 studies identified from the searches, five satisfied the inclusion criteria and were included in the data synthesis. Two were randomized controlled trials, and three used observational comparative designs assessed as being at low-to-moderate risk of bias. Regarding the primary outcome of mortality, there was no evidence from high-quality studies with a low risk of bias that prehospital administration of ABs decreased mortality when measured at 28, 30 or 90 days. Regarding secondary outcomes, there was no evidence from high-quality studies with a low risk of bias that prehospital ABs reduce the length of stay in the hospital generally or the intensive care unit. The certainty of findings was low for mortality at 90 days, and very low for measurement at 28 and 30 days. There was insufficient evidence from high-quality studies with a low risk of bias indicating prehospital administration of ABs in addition to usual care, compared to usual care alone, reduces mortality at 28, 30 or 90 days, or length of stay in hospital or ICU, for adult patients with sepsis. There is insufficient evidence to enable the recommendation of routine administration of antibiotics to patients with sepsis presenting to ambulance service clinicians in the prehospital setting. Investigation of administration to more severe sepsis presentations in settings where prolonged prehospital intervals are inherent is warranted.

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“…Následné prospektivní studie [4][5][6][7][8] však podobnou korelaci neprokázaly, odklad v podání antibiotik v rozsahu několika hodin nezhoršoval prognózu septických nemocných. Vysvětlením uvedeného rozdílu mezi staršími observačními a novějšími prospektivními studiemi by mohla být skutečnost, že podání antibiotik je obvykle nedílnou součástí komplexní léčebné péče.…”

Section: úVodunclassified

Initial antibiotic treatment of serious bacterial infections

Beneš¹

2019

Vnitř Lék

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Článek shrnuje známá fakta týkající se výběru antibiotik pro léčbu sepse a podobných závažných infekcí, jejich mechanizmu účinku, dávkování a způsobu podávaní. Zvláštní pozornost je věnována otázce včasného zahájení antibiotické léčby: několikahodinový odklad v zahájení antibiotické terapie lze tolerovat, je-li využit pro stanovení etiologie nemoci a zpřesnění léčby. U perakutně probíhajících infekcí či toxoinfekcí je však nutné podat antibiotika skutečně neodkladně; v článku jsou připomenuty diagnostické postupy, které klinik při rozvaze o volbě přípravku může využít.Klíčová slova: antibiotická léčba -iniciální léčba -nasycovací dávka -perakutně probíhající infekce -sepse Initial antibiotic treatment of serious bacterial infections SummaryThe article summarizes the known facts regarding the selection of antibiotics for the treatment of sepsis and similar serious infections, their mechanism of action, dosage and mode of administration. Particular attention is paid to early antibiotic therapy: a delay of several hours in the onset of antibiotic therapy can be tolerated if it helps to clarify the aethiology and to refine the treatment. However, in case of the very acute infections it is necessary to start antibiotic treatment immediately; diagnostic procedures are mentioned that can be used for the selection of the appropriate drug.

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Use of antibiotics in the ambulance for sepsis patients: is earlier really better?

Cited by 4 publications

References 15 publications

Author’s response to commentary on the PHANTASi trial

Author’s response to commentary on the PHANTASi trial

Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – a systematic review

Initial antibiotic treatment of serious bacterial infections

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