Antibiotics for Sepsis – Does Each Hour Really Count? Or is it Incestuous Amplification? – by Prof Mervyn Singer
“Each hour’s delay in initiating antibiotics costs lives” is a doctrine that has attained quasi religious status. Like most (quasi)religions, this is founded more on faith and hope than hard fact. With the failure of other beliefs previously touted as incontrovertible, such as the 24-hour sepsis management bundles and, more recently, a specific early goal-directed therapy strategy, we need to believe we are offering some benefit to our acutely ill patients. A blind faith in the primacy of early antibiotics suits this purpose, yet I confess to being decidedly agnostic and fearful. The increasing level of antimicrobial resistance is rightly viewed as a global crisis. The indiscriminate and inappropriate use of antibiotics will only serve to accelerate this problem. Furthermore, antibiotics themselves also cause harm—for example, organ injury, mitochondrial dysfunction, the impact on the microbiome, and overgrowth by fungi and Clostridium difficile

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