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Sepsis

Emergencies

Guidance changed 23 Sept 2026. NICE NG253 now uses NEWS2 risk labels (medium, not moderate), asks for medical review before a single score of 3 sets the risk level, and adds procalcitonin testing.

For adults (16+, not pregnant) NICE NG253 risk-stratifies with NEWS2 and sets antibiotic timing by risk: 1 h, 3 h or 6 h.

Fluid boluses are 250 mL, not 500 mL. Risk levels now use NEWS2 labels (high / medium / low).

Act now

  1. 1

    High risk: urgent assessment by a clinician FY2 or above; broad-spectrum IV antibiotics within 1 hour of the NEWS2 score; IV fluid bolus within 1 hour unless contraindicated; refer to the senior clinical decision maker.

  2. 2

    Medium risk: bloods including venous gas with lactate; FY2+ review of the patient and lactate within 1 hour; antibiotics within 3 hours. Treat as high risk if lactate >2 mmol/L or AKI.

  3. 3

    Low risk: registered health practitioner review within 1 hour; antibiotics (if indicated) within 6 hours.

Assess

  • Suspected or confirmed infection plus NEWS2. Interpret in light of usual physiology and comorbidities.
  • High risk: NEWS2 ≥7; or below 7 with a single parameter scoring 3 that a medical review confirms as high risk, or other clinical reasons for concern.
  • Medium risk: NEWS2 5–6; or below 5 with a single parameter scoring 3 that a medical review confirms as medium risk, or other clinical reasons for concern.
  • Low risk: NEWS2 1–4, or 0 with cause for clinical concern.

Investigations

  • Blood cultures before antibiotics (without delaying them), venous gas with glucose and lactate, FBC, CRP, U&E, creatinine, LFTs, clotting.
  • Consider procalcitonin in medium- and high-risk patients if the result will be available in time (new in NG253, September 2026).
  • Source-directed samples and imaging (urine, sputum, CXR, wound swabs).

Manage

  • Fluids: isotonic crystalloid (balanced solution such as Hartmann's; 0.9% saline if unavailable). 250 mL ideally over 10–15 minutes, repeat up to 1000 mL total including fluid already given, reassessing after each bolus.
  • Not improved after 1000 mL: get senior advice.
  • Choose antibiotics using local microbiology guidance and the likely source; look for a source that needs surgical or radiological control.
  • Recalculate NEWS2 regularly per NEWS2 guidance.

Escalate when

  • High risk with no response within 1 hour of any intervention: senior decision maker to attend in person, discuss with critical care, inform the responsible consultant.
  • Discuss vasopressors (including peripheral start if no central access) with critical care or the senior decision maker, after a shared decision about escalation.

Doses and prescribing

Check allergy status and renal function; doses of aminoglycosides and some beta-lactams need adjusting.

Peripheral vasopressors: follow local policy on drug, concentration and monitoring; watch the cannula for extravasation. Use is off-label for some agents.

Pregnant or recently pregnant patients and under-16s follow different guidelines (NG255, NG254).

Check the BNF and your local formulary before prescribing.

Written to current guidance (NICE NG253) · sources checked 14 Nov 2026. We watch NICE for updates weekly.

Sources (2)

Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026

Calculators for this

For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.