Sepsis 2026: How Fast Should You Give Antibiotics? | Part 2

How fast should antibiotics begin, how broad should treatment be, and when can you narrow or stop it? Part 2 of our five-part Sepsis 2026 series examines infection management in the Surviving Sepsis Campaign adult guidelines. We cover antimicrobial timing, source control, resistance risks, selective antifungal and anaerobic coverage, rapid diagnostics, prolonged beta-lactam infusion, therapeutic drug monitoring, de-escalation, treatment duration, procalcitonin and selective digestive decontamination. Scope: recommendations 16–41, from the Infection heading on printed page 881 to the end of that section on page 892. Part 3 will cover hemodynamic support. We distinguish recommendation strength from evidence certainty, association from causation, and pooled evidence from later trial findings. Presented by Stefan Porubcin, MD, PhD., Associate Professor of Internal Medicine. PRIMARY SOURCE Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52:863–936. doi:10.1007/s00134-026-08361-1. https://link.springer.com/article/10.... Supplementary methods (SDC1) and infection evidence profiles (SDC4) are available with the article. Original Figure 2 and selected recommendation boxes, evidence profiles and forest plots remain attributed to SSC 2026 and SDC4. Clinical illustrations are conceptual; they are not diagnostic images or measured patient data. SDD is illustrated with oral paste and a gastric suspension through a separate gastric tube. The main infection section, selected methods and the displayed supplementary profiles were reviewed. This is not a new meta-analysis or an independent audit of every included trial or individual conflict disclosure. The beta-lactam recommendation box reports moderate certainty, while its mortality evidence profile reports high certainty; both are identified in the episode. ADDITIONAL PRIMARY TRIALS FOR THE QUANTITATIVE TEACHING SLIDES BALANCE Investigators. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025;392:1065–1078. doi:10.1056/NEJMoa2404991. https://doi.org/10.1056/NEJMoa2404991 Dark P, Hossain A, McAuley DF, et al. Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA. 2025;333(8):682–693. doi:10.1001/jama.2024.26458. https://jamanetwork.com/journals/jama... ADAPT-Sepsis correction (noninferiority wording and supplementary eFigure 3): JAMA. 2026;335(2):187. doi:10.1001/jama.2025.25495. https://jamanetwork.com/journals/jama... These numerical additions come from the original trials. BALANCE establishes noninferiority in selected bloodstream infections; ADAPT-Sepsis supports shorter antibiotic exposure with a prespecified mortality safety margin. Neither result demonstrates a mortality benefit. CHAPTERS 00:00 The Evidence Explained: the clinical question 00:38 Part 2 of 5: infection management 01:06 Practice Check: recommendations and certainty 01:30 Antimicrobial timing: shock and infection likelihood 03:04 Antibiotics before hospital arrival 03:39 Procalcitonin and starting treatment 04:05 Source control 05:13 Specific resistance risks 05:50 Anaerobic coverage 06:24 Antifungals and Candida biomarkers 07:40 Rapid diagnostics and surveillance 08:43 Beta-lactam loading and prolonged infusion 09:51 Therapeutic drug monitoring 10:27 Reassessment and de-escalation 12:16 Duration and stopping treatment 14:14 Selective digestive decontamination 15:34 Clinical pathway and take-home messages 16:55 Article and sources Educational analysis for clinicians. Apply recommendations with clinical judgment, local microbiology and the resources available to the treating team. This video does not replace individualized care or local protocols.