Antibiotics (neonatology)

The initial clinical signs of infection in the newborn tend to be non-specific, however, delays in starting treatment can have serious consequences. Therefore, in case of clinical suspicion of infection, empirical antibiotic therapy should be initiated immediately after collections of samples for culture cultivation. The duration of treatment depends on the clinical response, the type of pathogen and the location of the infection. Combinations of antibiotics are often given to cover a wider range of pathogens, to exploit the synergistic effect and to prevent the development of resistance.

The following groups of antibiotics are most often used in neonatology:
 * Beta-lactam antibiotics:
 * narrow-spectrum penicillins: penicillin G, oxacillin;
 * broad-spectrum penicillins: ampicillin, amoxicillin;
 * penicillins with beta-lactamase inhibitors: clavulanic acid (Amoxiclav®, Augmentin®), sulbactam (Unasyn®), tazobactam (Tazocin®);
 * 3rd generation cephalosporins: ceftriaxone, cefotaxime, ceftazidime
 * → gram-negative meningitis, pneumococcal infections, etc.; ceftazidime → pseudomonas infections.
 * carbapenems: meropenem
 * → very broad spectrum (all bacteria except Enterococcus faecium, Burkholderia cepacia, MRSA); parenteral administration only.
 * Aminoglycosides: gentamicin, amikacin
 * → gram-negative aerobic bacteria; parenteral administration only; bactericidal.
 * Glycopeptides: vancomycin, teicoplanin;
 * → gram-positive bacteria;
 * Nitroimidazoles: metronidazole;
 * → anaerobic bacteria;
 * Macrolides: azithromycin.

Early neonatal sepsis

 * development of sepsis in the first 48 (72) hours of life;
 * most commonly caused by mother-borne bacteria (Streptococcus agalactiae, Escherichia coli);
 * 1st choice antibiotics: penicillin + gentamicin, if Listeria monocytogenes is supected then ampicillin + gentamicin;
 * empirical antibiotic therapy should be discontinued after 36-48 hours if the blood culture is negative and the newborn has no clinical signs of infection.

Late neonatal sepsis
You can find more detailed information on the page Neonatal Sepsis
 * development of sepsis after the first 48 (72) hours of life;
 * most often caused by staphylococci (CoNS, S. aureus) or enterobacteria;
 * 1st choice antibiotics: oxacillin + gentamicin;
 * in suspected sepsis with negative blood culture ("clinical sepsis"), are antibiotics usually administred for 5 days;
 * in case of positive blood culture, antibiotics are administered for at least 10 days; in the treatment of St. aureus for at least 14 days - in consultation with a microbiologist;
 * in case of positive cultivation of cerebrospinal fluid or clinical signs of meningitis, the treatment lasts at least 21 days;
 * treatment of osteomyelitis, endocarditis or deep abscess takes number of weeks

Meningitis
You can find more detailed information on the page Purulent meningitis (pediatrics)
 * antibiotics: cefotaxime + amoxicillin or penilin G ± gentamicin.

Necrotizing enterocolitis
You can find more detailed information on the page Necrotizing enterocolitis

Urinary tract infections
You can find more detailed information on the page Urinary tract infections

Bacterial resistance
More detailed information can be found on the pages Antibiotic resistance, Beta-lactamases, Resistance to macrolides and lincosamides (main causes of resistance, efflux).

Related articles

 * Neonatal infections
 * Antibiotics

Literature

 * RENNIE, JM, et al. Textbook of Neonatology. 5. vydání. Churchill Livingstone Elsevier, 2012. s. 1025.  ISBN 978-0-7020-3479-4.
 * GOMELLA, TL, et al. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 7. vydání. Lange, 2013. s. 944-1001.  ISBN 978-0-07-176801-6.