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nashwa

guideline of starting antibiotic

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Late preterm baby 36 w , delivered by CS to IDM with no risk factor of sepsis

Presented with RD after birth .? TTN ....can I start antibiotic from start till result of CBC , CRP appear and if negative I stop antibiotic within 48h or I should do also blood culture....or not start antibiotic from start.?

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According to me,if no risk factors no need of antibiotics at start.ttn will resolve in 24 hrs.if no response or any evidence of poor perfusion,inotropes requirement,send cbc crp blood culture n start antibiotics.if cbc crp normal,ct.antibiotics till culture negative.if no adequate response then ct antibiotics for 5-7 days.

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The Kaiser Permanente early onset sepsis calculator gives a great insight into this problem ... http://www.dor.kaiser.org/external/DORExternal/research/InfectionProbabilityCalculator.aspx

 

Anyway from the data provided the EOS risk is very low and observation is all that is needed unless clinical features of sepsis appear.

 

By the way, why wait to stop antibiotics at 48 hours? EOS cultures are almost always positive by 24 hours or not at all.

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Most units I have worked in will take the pragmatic view of starting antibiotics if you have respiratory signs. Antibiotics can be stopped within 24 to 36hrs if inflammatory markers normal and culture negative. That's what I'll do. TTN is usually a diagnosis of exclusion.

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thanks for your interesting to reply on my Q

as i know, TTN is a diagnosis of exclusion , so early RD  in neonate ...may be congenital pneumonia even if no risk factor present

so i asked about

1st. can i start antibiotic from begining till result of cbc , crp  appears

or 2nd. not start at all

or 3rd. doing also blood culture and if this done am i waiting till result appears " continuing on antibiotics"

thanks for sharing experience

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its better to adopt more aggressive managment i.e starting antibiotic early as R.D ( deterioration can be rapidly ).

anyway follow your local giudlines and adjust accordingly .

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