Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates: a pilot study.
BACKGROUND
To identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis (EOS).


METHODS
This is a retrospective study conducted at a Malaysian government hospital. Records of neonatal patients admitted within 72 h of life and prescribed with empirical antibiotic therapy for suspected EOS were reviewed.


RESULTS
Three hundred and twenty-three cases met the inclusion criteria and were divided into gestational age (premature < 36 weeks; term ≥ 37 weeks) and birth weight (low birth weight (LBW) < 2.5 kg; normal body weight (NBW) ≥ 2.5 kg) groups. Premature (n = 197) and LBW (n = 194) neonates required significantly longer hospital stay, a higher degree of ventilator support and more surfactant (p = 0.001). More than 90.0% of premature and LBW neonates were diagnosed with respiratory distress syndrome, congenital pneumonia and presumed sepsis. Term (n = 123) and NBW (n = 129) neonates had greater maternal risk factors, especially meconium-stained amniotic fluid (MSAF) and perinatal asphyxia. The incidence of demonstrated EOS was 3.1%. Crystalline penicillin plus gentamicin was the standard therapy for all groups and was started within 24 h of life, with a mean treatment duration of ∼4 days. The treatment success rate was 89.0%, and only LBW neonates showed a higher risk of overall treatment failure (OR = 3.75; 95% CI: 1.22-11.53). Seventy-four percent of term and NBW neonates discharged well, while 42.0% of premature and LBW neonates required referral.


CONCLUSIONS
Crystalline penicillin plus gentamicin prescribed within 24 h of life is effective in the prevention of EOS. However, low birth weight neonates have a higher risk of treatment failure.
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
Mohamed Mansor
MM
Manan
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
Nazedah Ain
NA
Ibrahim
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
Noorizan Abd
NA
Aziz
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
Hanis Hanum
HH
Zulkifly
Pharmacy Practice Department, College of Pharmacy, Qassim University, Saudi Arabia.
Yaser Mohammed Ali
YM
Al-Worafi
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia; Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Malaysia.
Chiau Ming
CM
Long
clinical outcome; gentamicin; healthcare-associated infection; intensive care; newborn; pediatrics; penicillin