# Suspected Sepsis (Emergency Referral) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Surviving Sepsis Campaign Guidelines 2021 · NICE Guideline NG51: Sepsis 2016 (updated 2024) · Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary-care prescription. · Egyptian National Drug Formulary - Antimicrobial 2023 - Verified date: 2026-08 ## Verified against - Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary-care prescription. - Egyptian National Drug Formulary - Antimicrobial 2023 ## Treatment metadata - No drug therapy in primary care (Emergency Referral) - Ceftriaxone — 1000 mg — injection ## Complete treatment card ```text SUSPECTED SEPSIS (EMERGENCY REFERRAL) Sources: Surviving Sepsis Campaign Guidelines 2021 · NICE Guideline NG51: Sepsis 2016 (updated 2024) · Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary- care prescription. · Egyptian National Drug Formulary - Antimicrobial 2023 Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - The picture varies enormously with where the patient sits between a systemic inflammatory response and full septic shock [shock] - Illnesses that worsen the outlook: active cancer, diabetes, chronic lung disease, heart failure, kidney impairment and cirrhosis [cirrhosis] - Being older than 65 years old independently predicts death, as adaptive immunity weakens with age - Sex does not appear to change mortality; the studies disagree - Any of those coexisting illnesses should raise the suspicion and push you to act sooner - Ask about recent illness, time in hospital and contact with drug-resistant organisms, since these steer the choice of treatment - The commonest sources, in order, are pneumonia, infection inside the abdomen, and urinary infection - Death is not tied to which site or which organism, resistant ones included, yet finding the source early still matters SIGNS - what you find (9) - Examination supplies the vital signs, which is what makes any bedside screening possible - Whatever the criticism of scoring, watching for abnormal vital signs and a body-wide response to infection still holds good - The lungs fail as acute respiratory distress syndrome [breathlessness] - The circulation fails as septic shock, meaning low blood pressure [hypotension · shock] - The kidneys fail as acute kidney injury - The brain fails as septic encephalopathy [sepsis] - The marrow fails as the anaemia of critical illness [anaemia] - Muscle and peripheral nerve fail as critical illness myopathy and polyneuropathy - Take the vitals fast, then examine thoroughly for a source, including a pelvic examination where that is relevant TESTS (12) - There is no reference-standard test for sepsis, which is why no bedside tool catches every case - Diagnosis rests on three things together: body-wide features, evidence of failing organs, and microbiology - Failing organs show up in platelets, bilirubin, INR, creatinine and lactate, among other markers - Microbiology usually means blood cultures, and can extend to urine, peritoneal or joint fluid, respiratory secretions and CSF - In over a third of clinical sepsis cases the blood cultures come back negative, and contaminants muddy the picture further - Organ dysfunction markers: systolic below 90 mm Hg, mean arterial pressure below 65 mm Hg, or respiratory failure needing ventilation - More markers: creatinine over 2.0, urine output under 0.5 ml/kg/hour across 2 consecutive hours, total bilirubin over 2 mg/dl - And: platelets under 100,000, INR above 1.5, aPTT above 60 seconds, or lactate above 2 mmol/L - Core workup is a full blood count with differential, a comprehensive metabolic profile, lactate, and clotting - The critical lactate value is greater than 2 mmol/L; INR and aPTT climb acutely as organs fail - Chest film and urinalysis hunt the source; take at least 2 blood cultures before the antibiotic, plus cultures from any likely site - Of uncertain value: procalcitonin, CRP, lipase, venous gas, a DIC panel, TSH, rapid flu and virus panels, and CT or spinal MRI depending on the suspected site IF NOT THIS - what else fits (12) - Adrenal insufficiency - Thyrotoxicosis - Salicylate poisoning - Anticholinergic poisoning - Malignant hyperthermia - Neuroleptic malignant syndrome - Heat stroke - Major trauma - Pancreatitis - Anaphylaxis - Extensive burns - The other kinds of shock: cardiogenic, obstructive and hypovolaemic Score WHO Emergency Triage (sick child) - Is this sick child safe to wait? Score qSOFA (quick SOFA) - Is this infection likely to go badly? Source StatPearls "Bacterial Sepsis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (EMERGENCY REFERRAL) [1st line] Adult Source Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary- care prescription. Why Sepsis is a medical emergency requiring rapid hospital transfer for diagnostic blood cultures, IV fluid resuscitation, and broad-spectrum IV antimicrobials within the first hour. Caution TIME-CRITICAL EMERGENCY: Red flag signs include altered mental status, systolic BP <90 mmHg, respiratory rate >=22/min, non-blanching rash, or anuria. Do not delay hospital transport for primary care procedures; communicate suspected sepsis to receiving emergency department. 2. CEFTRIAXONE [add-on - not a substitute] Adult IV or IM 1–2 g once or devided twice daily. Peds 80 mg/kg/dose [child max 2000 mg] (Severe infection (eg, meningitis, penicillin-resistant pneumococcal pneumonia): 100 mg/kg/day divided every 12 to 24 hours; maximum daily dose: 4,000 mg/day) 3kg -> 240 mg/dose 4kg -> 320 mg/dose 5kg -> 400 mg/dose 6kg -> 480 mg/dose 7kg -> 560 mg/dose 8kg -> 640 mg/dose 9kg -> 720 mg/dose 10kg -> 800 mg/dose 11kg -> 880 mg/dose 12kg -> 960 mg/dose 13kg -> 1040 mg/dose 14kg -> 1120 mg/dose 15kg -> 1200 mg/dose 16kg -> 1280 mg/dose 17kg -> 1360 mg/dose 18kg -> 1440 mg/dose 19kg -> 1520 mg/dose 20kg -> 1600 mg/dose 21kg -> 1680 mg/dose 22kg -> 1760 mg/dose 23kg -> 1840 mg/dose 24kg -> 1920 mg/dose 25kg -> 2000 mg/dose 26kg -> 2000 mg/dose (capped) 27kg -> 2000 mg/dose (capped) 28kg -> 2000 mg/dose (capped) 29kg -> 2000 mg/dose (capped) 30kg -> 2000 mg/dose (capped) 31kg -> 2000 mg/dose (capped) 32kg -> 2000 mg/dose (capped) 33kg -> 2000 mg/dose (capped) 34kg -> 2000 mg/dose (capped) 35kg -> 2000 mg/dose (capped) 36kg -> 2000 mg/dose (capped) 37kg -> 2000 mg/dose (capped) 38kg -> 2000 mg/dose (capped) 39kg -> 2000 mg/dose (capped) 40kg -> 2000 mg/dose (capped) 41kg -> 2000 mg/dose (capped) 42kg -> 2000 mg/dose (capped) 43kg -> 2000 mg/dose (capped) 44kg -> 2000 mg/dose (capped) 45kg -> 2000 mg/dose (capped) 46kg -> 2000 mg/dose (capped) 47kg -> 2000 mg/dose (capped) 48kg -> 2000 mg/dose (capped) 49kg -> 2000 mg/dose (capped) 50kg -> 2000 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why NICE NG51 permits pre-hospital broad-spectrum IV/IM antibiotic administration when hospital transfer is delayed by over 1 hour. Caution Only administer pre-hospital antibiotics if it does not delay immediate emergency transfer. Contraindicated in patients with severe cephalosporin or penicillin anaphylaxis. The formulary's paediatric figure for a severe infection is 100 mg/kg/day, maximum 4 g, and 50 mg/kg every 24 hours in a neonate. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)