In a recent randomized, controlled trial of approximately 2,700 patients, antibiotics were administered by EMS prior to emergency department arrival in 1,548. The difference in median time to antibiotics was approximately 96 minutes, resulting in no mortality difference between early EMS-administered antibiotics and usual care where antibiotics were administered after assessment in the ED.10
Attempts to meet a one-hour timeline in undifferentiated patients will result in antibiotics administration to patients who ultimately did not require them. The unanswered question is, would one or two doses of unnecessary antibiotics be harmful? That risk must be quantified and compared to the risk of antibiotics being potentially delayed in those who do need them while determining bacterial infection.
Current data are imperfect. One retrospective evaluation of gram-negative severe sepsis or septic shock found those who previously received antibiotics within 90 days of admission had an increased length of stay, increased mortality, and increased cost.11