Empiric Antimicrobials for Neonatal Sepsis

Neonatal sepsis is a common cause of morbidity and mortality among young infants. Early-onset sepsis occurs in the first 3 days of life and is typically caused by Escherichia coli or group B streptococcus. Late-onset sepsis occurs from days 4 to 30 of life and is most often due to gram-positive organisms. Because the initial presentation of neonatal sepsis is often subtle, antibiotics are usually started empirically while culture results are pending. The choice of empirical antibiotics must balance the potential risks of providing ineffective treatment of the ultimately discovered pathogen with the definite risks of broad-spectrum antibiotic exposure. For most infants, a narrow empirical antibiotic regimen provides effective coverage without undue risk of infection-related morbidity or mortality. However, patient factors and local epidemiology should be considered when making antibiotic choices in order to optimize individual patient outcomes.