What is the role of antibiotic therapy in the treatment of neonatal early-onset bacterial infection associated with maternal chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Antibiotic therapy for early-onset bacterial infection of the neonate usually includes the administration of a penicillin (ie, ampicillin is most often used for additional coverage against Haemophilus species, enterococci, and listeriosis) and an aminoglycoside (ie, usually gentamicin). Generally, gentamicin provides ample coverage against gram-negative bacteria that cause EOS. The third-generation cephalosporins should be used as part of the antibiotic regimen if resistant E coli is suspected based on the maternal history, amniotic fluid culture results, and the clinical picture. Cefotaxime has been advocated by many experts when meningitis is suspected or when an asphyxiated infant or an extremely preterm infant is being treated and severe renal dysfunction may occur.

Antibiotic administration in newborns is based on birth-weight criteria and gestational age at birth. Doses of antibiotics change as the postnatal age increases and renal function improves. Administration of aminoglycosides should include changes in dosing based on pharmacokinetics.

Final decisions about antibiotics should be based on positive culture results from appropriate anatomic sites. If renal dysfunction is present, antibiotic dosages should be adjusted during the course of their administration. This is particularly true for aminoglycoside administration in extremely premature newborns and in newborns with urogenital anomalies.

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