The National Clinical Programme for Sepsis & the Irish College of GPs launched a General Practice Update on Adult sepsis in the community in 2024. It was acknowledged, at the time, that further discussion and analysis was required prior to providing guidance on the use of prehospital antibiotics, by GPs, in patients with suspected sepsis.
To develop this guidance further, an expert working group was formed. The working group's role and purpose was to review the available clinical evidence on the use of antibiotics in cases of suspected sepsis in the prehospital setting and discuss the feasibility, evidence, and implications of commencing antibiotics in a patient with suspected sepsis in the community setting.
Please see below the final recommendation of the expert group (full statement available here):
On review of the current literature, there is insufficient evidence to recommend the routine use of prehospital antibiotics in patients with suspected sepsis. Suspected meningococcal disease is the exception, where urgent administration of benzylpenicillin is recommended.
This guidance follows largely from the lack of validated diagnostics available in primary care to distinguish between infection, sepsis and other conditions that may masquerade as sepsis. The risk of exposing the patient population to the harms of widespread antibiotic usage is not currently balanced by any evidence-based patient benefit.
In Ireland, there is a recognised process in place to aid transfer of the patient to an acute hospital in a timely manner and the priority remains urgent transfer for acute hospital evaluation, diagnosis, and management. As in all situations in practice, the guidance does not replace clinical judgment.
The National Clinical Programme for Sepsis and the Irish College of GPs acknowledge the significant funding provided by HSE to support research and QI in primary care sepsis. This sepsis research in Irish general practice will help better understand and improve sepsis outcomes.