Principles around use of antibiotics for early-onset or late-onset neonatal infection

1.15 Principles guiding antibiotic decisions

1.15.1

Do not routinely give antibiotic treatment to babies without risk factors for infection or clinical indicators or laboratory evidence of possible infection. [2012]

1.15.2

If a baby needs antibiotic treatment, give this as soon as possible and always within 1 hour of the decision to treat. [2021]

1.15.3

Do not use C-reactive protein results alone to make decisions about starting, continuing or stopping antibiotics. [2026]

1.15.4

Regularly reassess the clinical condition and results of investigations in babies receiving antibiotics. Consider whether to change the antibiotic regimen, taking account of:

the baby's clinical condition (for example, if there is no improvement)
the results of microbiological investigations
expert microbiological advice, including local surveillance data. [2012]

For a short explanation of why the committee made the 2026 recommendation and how it might affect practice, see the rationale and impact section on principles guiding antibiotic decisions.

Full details of the evidence and the committee's discussion are in evidence review R: switching from intravenous to oral antibiotics for suspected early-onset neonatal infection.

1.16 Service and staffing requirements

1.16.1

Consider establishing hospital systems to provide blood culture results 36 hours after starting antibiotics for early-onset neonatal infection, to allow timely stopping of treatment and discharge from hospital. [2012]

1.16.2

Healthcare professionals with specific experience in neonatal infection should be available every day to give clinical microbiology or paediatric infectious disease advice. [2021]

For a short explanation of why the committee made the 2021 recommendation and how it might affect practice, see the rationale and impact section on infectious disease advice.

Full details of the evidence and the committee's discussion are in evidence review H: antibiotics for treating late-onset neonatal infection.