PHANTASi
Prehospital Antibiotics Against Sepsis
Patient / Population Intervention / Exposure Comparison Outcome
In2672 adults with suspected sepsis,prehospital ceftriaxone in the ambulancedid not reduce28-day all-cause mortalitycompared withusual care.
N
2,672
Design
Multicentre, open-label, randomised controlled trial in ten regional ambulance services serving 34 hospitals in the Netherlands; 1:1 block randomisation stratified by region, intention-to-treat analysis, preceded by EMS training in sepsis recognition
Endpoint
All-cause mortality at 28 days
Result120/1535 (8%) died in the prehospital ceftriaxone group vs 93/1137 (8%) with usual care (RR 0.95, 95% CI 0.74–1.24). No difference in in-hospital or 90-day mortality, ICU admission or hospital length of stay. Antibiotics were given a median 26 min (IQR 19–34) before ED arrival, vs a median door-to-antibiotic time of 70 min (IQR 36–128) with usual care after training (93 min, IQR 39–140, before training; p=0.142). 28-day re-admission was lower with the intervention (102 [7%] vs 119 [10%], p=0.0004). Seven mild allergic reactions occurred, none attributable to ceftriaxone; no anaphylaxis.
Alam N, Oskam E, Stassen PM, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med. 2018;6(1):40–50. 10.1016/s2213-2600(17)30469-1