Empirical treatment of neonatal sepsis: are the current guidelines adequate?

Abstract

Current guidelines for empirical therapy in neonates with sepsis are appropriate. However, gentamicin-based regimens should be used in preference to cefotaxime-based treatments, because of lower levels of susceptibility to cefotaxime and the need to avoid exerting selective pressure for resistance. Surveillance data linked to clinical data should further inform rational antibiotic prescribing in neonatal units.

Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009–2010

“…A current publication from England showed a slightly higher rate of cephalosporin-resistance of 5% in late onset sepsis (LOS) E. coli strains [10]. The same study showed that 93% of LOS E. coli strains remained susceptible to a combination of amoxicillin and gentamicin.…”

Pattern of antibiotic use in neonatal intensive care unit in tertiary care hospital in Southern India

“…15 Second most commonly used antibiotic in this study was amikacin and 75% of preterm neonates were receiving amikacin. Dose of amikacin should be once every 36 hours in babies less than 32 weeks of gestation and for all other babies dose is once every 24 hours.…”

Evolución clínica en recién nacidos con presunción de sepsis nosocomial tratados con cefazolina o vancomicina. Estudio de no inferioridad, aleatorizado, controlado

“…En recién nacidos con sepsis nosocomial confirmada o altamente probable, la cefazolina no fue inferior a la vancomicina en el logro de un resultado clínico adecuado. 4 L a v a n c o m i c i n a e s u n o d e los antibióticos de elección ante la presunción de sepsis por SCN y otros gérmenes Gram positivos, y se emplea en el tratamiento empírico inicial en sepsis tardía o nosocomial, [5][6][7] habitualmente asociada a un antibiótico de amplio espectro. Su excesivo uso provoca diversos problemas, posibles efectos adversos, mantenimiento prolongado de vías intravenosas y la aparición de resistencia bacteriana, que es el que ha merecido mayor preocupación en la búsqueda de estrategias para reducirla.…”