How long are antibiotics indicated for the treatment of neonatal infection related to chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Lastly, the physician must consider the duration of antibiotic therapy. This is particularly true when deciding the duration of antibiotic treatment for well-appearing term neonates. In the era of managed care, in which cost reductions are typical, discontinuing antibiotics in healthy term neonates within 36-48 hours of initiating therapy is probably safe. With current bacteriologic techniques, more than 90%-95% of neonatal blood cultures become positive within 48 hours of the time they are cultivated. A negative C-reactive protein (CRP) result when reviewed at 48 hours after birth suggests antibiotic treatment can be stopped.

In neonates with proven infection, the well-being of the infected newborn should guide the duration of antibiotic therapy. The bacterium causing the infection and the site of the infection also influence the duration of antibiotic therapy. For example, bacterial pneumonia is often treated for 7-10 days with antibiotics. Bacteremia is often treated with antibiotics for 10-14 days. This duration is based on the potential for recurrence with shorter courses of treatment (ie, 10 days of antibiotics is often considered a minimum for GBS-associated bacteremia).

Cerebrospinal fluid (CSF) infections may require antibiotic therapy for 2-4 weeks based on the bacterium responsible for the infection, findings on an analysis of CSF indicating resolution of the infection, and the presence of complications associated with meningitis. For uncomplicated GBS-related infections of the CSF, 2 weeks may be sufficient; infection with other gram-positive pathogens and all gram-negative bacteria often require 3-4 weeks of antibiotic therapy. Surgical interventions for localized central nervous system infections (eg, an infectious epidural collection, brain abscess) or the presence of postinfectious hydrocephalus may indicate that antibiotic therapy needs to be provided for as long as 4-6 weeks.

Information in the following section reviews the antibiotics that are commonly used to treat early-onset bacterial infections in the neonate. The antibiotics covered are not exhaustive. For example, the use of azithromycin to treat congenital pneumonia caused by U urealyticum or Mycoplasma is not reviewed.


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