Neonatal infection: antibiotics for prevention and treatment

For babies with suspected late-onset neonatal infection who are already in a neonatal unit:

• give a combination of narrow-spectrum antibiotics (such as intravenous flucloxacillin plus gentamicin) as first-line treatment

• use local antibiotic susceptibility and resistance data (or national data if local data are inadequate) when deciding which antibiotics to use

• give antibiotics that are effective against both Gram-negative and Gram-positive bacteria

• if necrotising enterocolitis is suspected, also include an antibiotic that is active against anaerobic bacteria (such as metronidazole). [2021]

For babies with suspected late-onset neonatal infection or meningitis who have been admitted from home, treat according to recommendations 1.8.6 and 1.8.7 in NICE's guideline on suspected sepsis in under 16s. [2021]

When using gentamicin, see the section on therapeutic drug monitoring for babies receiving gentamicin. [2021]

For babies given antibiotics because of suspected late-onset infection, consider stopping the antibiotics at 48 hours if:

• the blood culture is negative and

• the initial clinical suspicion of infection was not strong and

• the baby's clinical condition is reassuring, with no clinical indicators of possible infection and

• the levels and trends of C‑reactive protein concentration are reassuring. [2021]

Give antibiotic treatment for 7 days for babies with a positive blood culture. Consider continuing antibiotic treatment for more than 7 days if:

• the baby has not yet fully recovered or

• longer treatment is needed because of the pathogen identified on blood culture (for example, Gram-negative bacteria or Staphylococcus aureus; seek expert microbiological advice if necessary) or

• longer treatment is needed because of the site of the infection (such as intra-abdominal co-pathology, necrotising enterocolitis, osteomyelitis or infection of a central venous catheter). [2021]

Use a shorter treatment duration than 7 days when the baby makes a prompt recovery, and either no pathogen is identified or the pathogen identified is a common commensal (for example, coagulase negative staphylococcus). [2021]

If continuing antibiotics for longer than 48 hours for suspected late‑onset neonatal infection despite negative blood culture, review the baby at least once every 24 hours. At each review, decide whether to stop antibiotics, taking account of:

• the level of initial clinical suspicion of infection and

• the baby's clinical progress and current condition and

• the levels and trends of C-reactive protein. [2021]

For guidance on treatment duration for suspected or confirmed meningitis, refer to the section on meningitis (babies in neonatal units). [2021]