Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland.
OBJECTIVE
To review antibiotic and antifungal policies in British and Irish neonatal units (NNUs).


METHODS
A telephone survey was performed regarding empirical antimicrobial guidelines of NNUs in the UK and Republic of Ireland.


RESULTS
The response rate was 91% (202 of 222 NNUs). The guidelines from all responding units covered group B Streptococcus and Escherichia coli, the most common causes of neonatal septicaemia and meningitis. However, 19% did not cover Listeria, the cause of meningitis in 5% to 7% of cases in England and Wales. Second-line recommendations varied greatly between units, with widespread use of broad-spectrum agents. Fungal prophylaxis and treatment guidelines were generally rudimentary.


CONCLUSIONS
Empirical antimicrobial recommendations on many NNUs include broad-spectrum antibiotics without ensuring universal coverage of important pathogens. We raise concerns about the selection pressures exerted for resistant pathogens and invasive fungal disease, especially as few units specify fungal prophylaxis or treatment guidance. Development of rational guidelines for the UK and Irish neonatal units might help to optimize treatment while minimizing overuse of broad-spectrum agents.
Fernando
Andrew Michael Russell
AM
Division of Child Health, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
Heath
Paul Trafford
PT
Menson
Esse Natasha
EN
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods; D004352:Drug Resistance, Microbial; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D007494:Ireland / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards; D006113:United Kingdom / Q000453:epidemiology
D000890:Anti-Infective Agents