Associations between paracetamol administration and delayed intravenous antibiotic administration among patients with in‐hospital sepsis

BACKGROUND: Timely antibiotic administration is crucial for improving sepsis outcomes, but delays are common and multifactorial. Fever, a key feature of sepsis, is often treated with paracetamol, which may mask the condition and contribute to delays in time to antibiotic. OBJECTIVE: This study investigated the association between paracetamol and delayed antibiotic administration in hospitalized septic patients. METHODS: This was a retrospective study using data from a prospectively collected sepsis registry. The study was conducted at Songklanagarind Hospital, a quaternary care university-affiliated hospital in southern Thailand. Adult patients (≥15 years) admitted for ≥24 h who developed suspected sepsis between March 2023 and March 2024. Suspected sepsis was defined by a high National Early Warning Score (NEWS). We recorded paracetamol administration within 8 hours prior to the sepsis trigger (time zero). The primary outcome was the delay of ≥180 min from time zero to antibiotic administration. Logistic regression was used to assess the associations, adjusting for confounders. RESULTS: Among the 1634 sepsis events, 12.5% involved prior paracetamol use. Paracetamol administration was not associated with increased odds of delayed antibiotic treatment (adjusted odds ratio 1.29, 95% confidence interval 0.94-1.78, p = .12). It also did not affect the temperature trajectories. Higher temperature was associated with lower in-hospital mortality in patients who did not receive paracetamol but this association was reversed in those receiving paracetamol. CONCLUSION: In this study, paracetamol administration before a sepsis alert was not associated with a delay in antibiotic administration and did not affect temperature changes.