Antibiotic regimen | |
Empiric therapy | |
Early onset (<72 hours) | Ampicillin and an aminoglycoside (typically gentamicin)* |
Late onset (≥72 hours) – Admitted from the community | Preferred regimen – Ampicillin and an aminoglycoside (typically gentamicin)* Alternative – Ampicillin and an expanded-spectrum cephalosporin (eg, ceftazidime, cefepime, or cefotaxime [where available]) |
Late onset (≥72 hours) – Hospitalized since birth | Vancomycin or nafcillin/oxacillin¶, and An aminoglycoside (typically gentamicin)* |
Special circumstances: | |
Suspected meningitis (eg, CSF pleocytosis) | Same as above except substitute an expanded-spectrum cephalosporin (eg, ceftazidime, cefepime, or cefotaxime [where available]) for the aminoglycosideΔ |
Suspected pneumonia | Ampicillin and an aminoglycoside (typically gentamicin)* Alternatives:
|
Suspected infection of skin, umbilicus, soft tissues, joints, or bones (S. aureus is a likely pathogen) | Vancomycin and an aminoglycoside (typically gentamicin)*, or Vancomycin, nafcillin, and an aminoglycoside (typically gentamicin)*, or Vancomycin and an expanded-spectrum cephalosporin (eg, ceftazidime, cefepime, or cefotaxime [where available]) |
Suspected intravascular catheter-related infection | Vancomycin and an aminoglycoside (typically gentamicin)* |
Suspected infection due to organisms found in the gastrointestinal tract (eg, anaerobic bacteria) | Ampicillin, an aminoglycoside (typically gentamicin)*, and clindamycin Alternatives:
|
Pathogen-specific therapy | |
Group B Streptococcus | Penicillin G |
E. coli – Ampicillin-sensitive | Ampicillin |
E. coli – Ampicillin-resistant | Expanded-spectrum cephalosporin (eg, ceftazidime, cefepime, or cefotaxime [where available]) Alternative:
|
Multidrug-resistant gram-negative bacilli (including ESBL-producing organisms) | Meropenem |
L. monocytogenes | Ampicillin and gentamicin |
MSSA | Oxacillin/nafcillin or cefazolin |
MRSA | Vancomycin |
Coagulase-negative staphylococci | Vancomycin |
CSF: cerebrospinal fluid; E. coli: Escherichia coli; ESBL: extended-spectrum beta-lactamase; L. monocytogenes: Listeria monocytogenes; MSSA: methicillin-susceptible Staphylococcus aureus; MRSA: methicillin-resistant Staphylococcus aureus.
* In centers with a high prevalence of gentamicin resistance among gram-negative isolates, an alternative aminoglycoside (eg, amikacin) may be preferred. Refer to UpToDate's topics on neonatal sepsis for additional details.
¶ Nafcillin or oxacillin can be used in the empiric regimen in lieu of vancomycin if the neonate is not critically ill and has a recent negative MRSA screening test.
Δ If there is concern for meningitis caused by a multidrug-resistant gram-negative organism, a carbapenem such as meropenem is the preferred agent for empiric therapy.Do you want to add Medilib to your home screen?