Trial reportThe Lancet. Respiratory medicine2018
Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial.
Trial report in The Lancet. Respiratory medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 120 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Prospective Randomized Controlled Trial to Investigate the Effects of Training Emergency Medical Services (EMS) Personnel in Recognizing and Initiating Treatment in the Prehospital Setting Together With Early Administration of Antibiotics for Patients Suspected of (Severe) Sepsis and Septic Shock
Trial of Antimicrobial Restraint in Presumed Pneumonia
Who cites it
120 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Longer than 2 hours to antibiotics is associated with doubling of mortality in a multinational community-acquired bacterial meningitis cohort.Scientific reports · 2022Pooled it
- What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review.PloS one · 2019Pooled it
- Contextual factors related to ventilator mode during an embedded randomized trial: a longitudinal survey of clinicians.BMC health services research · 2026Trial
- Abrupt termination of vitamin C from ICU patients may increase mortality: secondary analysis of the LOVIT trial.European journal of clinical nutrition · 2023Trial
- Trial
- Randomised feasibility study of prehospital recognition and antibiotics for emergency patients with sepsis (PhRASe).Scientific reports · 2021Trial
- An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial.Critical care (London, England) · 2019Trial
- Time to Effective Antibiotic Therapy and Clinical Outcomes in Bloodstream Infections With ESBL-Producing Enterobacterales: A Retrospective Multicenter Cohort Study.Open forum infectious diseases · 2026Article
- Prehospital Administration of Antibiotics for Patients with Suspected Severe Infection: A Systematic Review and Meta Analysis.Antibiotics (Basel, Switzerland) · 2026Review
- Presenting Symptoms and Antibiotic Timing Among Hospitalized Adults With Presumed Sepsis.JAMA network open · 2026Article
- Evaluation of ambulance blood cultures in patients with suspected sepsis. A rural prospective cohort study.Infection · 2026Article
- Association of Timely Antibiotics and Fluid Resuscitation With Increased Discharge to Home After Sepsis.Chest · 2026Observational
- Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Association of antibiotic type and timing with sepsis mortality using target trial emulation.Scientific reports · 2026Article
- Early Identification of Sepsis by Emergency Medical Services: Diagnostic Accuracy of Scoring Systems in a Retrospective Cohort.Journal of clinical medicine · 2026Article
- Pre-Referral Antibiotics and Mortality Among Adults With Sepsis in Southeast Asia: A Secondary Analysis of a Prospective Cohort Study.Critical care medicine · 2026Article
- When randomisation goes horribly wrong: examples of major failures of randomisation and strategies to avoid them.Trials · 2025Review
60 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEmergency medical services (EMS) personnel have already made substantial contributions to improving care for patients with time-dependent illnesses, such as trauma and myocardial infarction. Patients with sepsis could also benefit from timely prehospital care.
methodsAfter training EMS personnel in recognising sepsis, we did a randomised controlled open-label trial in ten large regional ambulance services serving 34 secondary and tertiary care hospitals in the Netherlands. We compared the effects of early administration of antibiotics in the ambulance with usual care. Eligible patients were randomly assigned (1:1) using block-randomisation with blocks of size 4 to the intervention (open-label intravenous ceftriaxone 2000 mg in addition to usual care) or usual care (fluid resuscitation and supplementary oxygen). Randomisation was stratified per region. The primary outcome was all-cause mortality at 28 days and analysis was by intention to treat. To assess the effect of training, we determined the average time to antibiotics (TTA) in the emergency department and recognition of sepsis by EMS personnel before and after training. The trial is registered at ClinicalTrials.gov, number NCT01988428.
findings2698 patients were enrolled between June 30, 2014, and June 26, 2016. 2672 patients were included in the intention-to-treat analysis: 1535 in the intervention group and 1137 in the usual care group. The intervention group received antibiotics a median of 26 min (IQR 19-34) before arriving at the emergency department. In the usual care group, median TTA after arriving at the emergency department was 70 min (IQR 36-128), compared with 93 min (IQR 39-140) before EMS personnel training (p=0·142). At day 28, 120 (8%) patients had died in the intervention group and 93 (8%) had died in the usual care group (relative risk 0·95, 95% CI 0·74-1·24). 102 (7%) patients in the intervention group and 119 (10%) in the usual care group were re-admitted to hospital within 28 days (p=0·0004). Seven mild allergic reactions occurred, none of which could be attributed to ceftriaxone.
interpretationIn patients with varying severity of sepsis, EMS personnel training improved early recognition and care in the whole acute care chain. However, giving antibiotics in the ambulance did not lead to improved survival, regardless of illness severity.
fundingThe NutsOhra Foundation, Netherlands Society of Internal Medicine (NIV).
Indexed as
Identifiers
29196046What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.