title: Choice of antibiotics in late neonatal sepsis in the extremely low birth weight infant.
abstract: OBJECTIVE
  To review the choice of antibiotics in treating suspected late neonatal sepsis in infants weighing 1000 g or less in a neonatal intensive care unit.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  RESULTS
  Ninety-six infants weighing 1000 g or less were admitted to the neonatal intensive care unit during the study period. Sixty-two infants survived beyond four days of life and had at least one sepsis workup done to exclude late neonatal infection. Of the 62 study patients, 42 (68%) were started on ampicillin and netilmicin (A/N) and 20 (32%) were started on vancomycin and ceftizoxime (V/C) as the antibiotics of choice, pending culture results. Of the patients started on A/N, 17 of 42 had a positive blood culture compared with 11 of 20 on V/C (40% versus 55%, P=0.40). The mean (+/-SD) birth weight of infants started on A/N was 793+/-133 g compared with a mean of 728+/-153 g in the group that received V/C (P=0.09). Seven patients died in the A/N group compared with three in the V/C group (16.7% versus 15%, P=0.84). In addition to the sepsis episode studied, before they were discharged from hospital, 21 of 42 (50%) infants in the A/N group had further workups for suspected sepsis, compared with 16 of 20 (80%) (P=0.048) infants initially given V/C.
  
  
  CONCLUSIONS
  Ampicillin and netilmicin is a safe antibiotic combination for neonates suspected of late sepsis. This, in turn, may be important in reducing vancomycin overuse and the potential for bacterial resistance to this antimicrobial agent.
authors.affiliation: Joseph's Health Care London, Department of Paediatrics, Child Health Research Institute, University of Western Ontario, London, Ontario.
authors.forename: Tara R
authors.initials: TR
authors.lastname: Allen
authors.forename: Orlando P
authors.initials: OP
authors.lastname: da Silva