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Prolonged antibiotic therapy in NICU


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Dear NICU netters,

As we all know, prolonged ( > 2days) antibiotic therapy is harmful in very low birth weight infants. Is there any justification in continuing antibiotics for 7 days in spite of negative cultures? For instance, a 26 week delivered by C section for severe maternal PIH has absolute neutrophil count of 700 but blood culture is negative. Would you treat this infant with prolonged course of antibiotics?

Appreciate your thoughts


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Guest bbmalmberg

No I would not continue treatment since baby was born for maternal reasons. The white count will improve. I would watch very closely for s/s of infection (esp. if the baby has central lines)

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I would never continue antibiotics for 7 days in such baby, since mother is PIH , low ANC count can be explained secondary to this. Our practice is going to change soon and currently we are stopping antibiotics at 48hrs but soon will stop at 24hrs if 2 CBC are normal taken 8-12hrs apart as most of our culture if grew anything is within 24hrs, ( based on evidence based) and our audit results of last 4 years. Secondly prolonged antibiotics use can lead to adverse outcome in Preterm babies.

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in such case of moderate neutropenia there are many differential diagnosis other than sepsis how ever in this case i will continue antibiotics for the first 48 hours and i will give granulocyte colony stimulating factor gcsf if baby improved i will stop antibiotics and this what i did in many caseas before.

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The positive culture rates is only 40-50 % in the best of world institutions. Where and how shall we know that it is true negative or false negative ( unable to isolate the organisms due to variety of reasons)

How can we avoid stopping antibiotics in culture negative sepsis?

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A common neonatologist dilemma..

To stop or not to stop antibiotics

If you stop worry you may have missed culture negative sepsis, if you continue you may be abetting the emergence of resistant organisms. What is the way out? First of all start antibiotics only when it is needed, antibiotics started in neo's who is at low risk for sepsis, stop if culture is negative; clinical settings and positive sepsis markers culture is negative take your call and continue, and of course positive culture needs full course.

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