title: Duration of empirical antibiotic therapy for infants suspected of early-onset sepsis.
abstract: OBJECTIVE
  Clinicians' adherence to the Centers for Disease Control guidelines to prevent group B Streptococcus (GBS) early-onset sepsis (EOS) has reduced GBS EOS. Although evidence-based testing and empirical antibiotic initiation are likely saving lives, clinicians have less compelling data to guide duration of empirically initiated antibiotics when cultures remain sterile and clinical signs resolve quickly. Our purpose is to review current opinions and evidence influencing clinicians' choices for duration of empirically initiated antibiotics in newborns with sterile cultures.
  
  
  RESULTS
  Retrospective cohort studies indicate potential for harm with longer duration of empirical antibiotics for EOS when cultures are sterile. Cohort studies indicate timing of widely used tests used to estimate EOS risk affects their predictive value, and tests acquired 24-48 h postnatally may provide reassurance for safe discontinuation.
  
  
  CONCLUSIONS
  Every day clinicians caring for thousands of neonates in the United States stop antibiotics which were started empirically to treat EOS on the first postnatal day. Evidence is lacking to support a universal approach to decisions on duration of empirical antibiotics when cultures remain sterile. Reviewing predictive value relative to timing of laboratory testing can help clinicians develop locally appropriate antimicrobial duration decision-making guidelines.
authors: Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina 27710, USA. cotte010@mc.duke.edu
authors: C Michael
authors: CM
authors: Cotten
authors: P Brian
authors: PB
authors: Smith
mesh_terms: D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein