A Guide to Inpatient and Outpatient Treatment

The following is our recommended approach to treating sepsis in hospital and outpatient settings. It is provided as guidance to healthcare providers worldwide and should only be used by medical professionals in formulating their approach to sepsis. Patients should always consult with their providers before starting any medical treatment.

Sepsis is a life-threatening medical condition that occurs when an infection triggers an extreme response in the body. If not treated in time, sepsis can rapidly lead to organ failure, tissue damage, or death. Estimates indicate that 1 in 5 deaths worldwide is associated with sepsis.

Sepsis can be treated in both hospital and outpatient settings. Some general principles apply to both options, as follows:

  • Sepsis is a time-sensitive disease. Waiting until the diagnosis is confirmed will lead to excess morbidity and mortality.
  • Treatment should begin immediately upon suspicion of sepsis — with antibiotics targeted to treat the suspected infection, as well as the therapies recommended below.
  • If the patient is proven not to have sepsis, antibiotics can be stopped with no adverse effects.
  • Source control is essential. Sepsis cannot be cured until the source of infection is removed.
  • If a surgical source is suspected, providers should consult with the hospital emergency room, surgery, and/or Interventional Radiology.
Hospital Treatment Protocol (MHAT)
  • Melatonin: 6-10 mg nightly.

  • Hydrocortisone: 50 mg 50 mg intravenously every 6 hours, for at least 4 days and until patients are off vasopressors. If treatment is less than 10 days, a taper is not required.

  • Ascorbic acid (Vitamin C): 1.5 g intravenously every 6 hours for a minimum of 12 doses, ideally 16 doses. Should treatment be initiated in excess of 6 hours after presentation to the hospital, the dose should be increased to 3 g intravenously every 6 hours. With delays in treatment of greater than 24 hours, mega-dose vitamin C should be considered, namely 20-25 g intravenously every 12 hours.

  • Thiamine: 200 mg intravenously every 12 hours.

Outpatient Treatment Protocol (MCAZ+)
  • Melat