It depends on the most common pathogens in your area. In the first two months ampicillin with gentamicin have the best coverage for most area in the world. I am not familiar with the pathogens in your area so can not guarantee this will be the best comnination for empirical treatment. Some hospital prefer ampicilloin and cefotaxime due to the fact no pharmacokinetics need to be considered.

I depends where is the child delivered. if in our own hospital we start will ampicillin and gentamycin if the child is delivered at home or small delivery home we think of staph and cover with vancomycin

it depends on your area, in some hospital in Uk, they start by benzylpenicillin and gentamicin for newborn, dose adjusment for gentamicin is very imporatnt

In the name of Allah

In early onset sepsis ( < 7 days) : we start by ampicillin and gentamycin.

(Because GBS, E. coli and Listeria monocytogenes are common)

In late onset sepsis ( 7-90 days) :

1- at community acquired infections: we start by ampicillin and cefotaxime.

(Empirical therapy for late-onset disease acquired in the community should provide coverage for the same neonatal pathogens of early onset and for potential community acquired pathogens, such as S. pneumoniae ,N.meningitidis & H.influenza.Furthermore meningitis frequently is a component of late-onset sepsis)

2- at nosocomial acquired infections: we start by Vancomycin and cefotaxime.

(CONS, enterococci, gram-negative enteric bacilli (including drug-resistant strains) are common in nosocomial infections.Vancomycin generally is active against all staphylococcal species, streptococci, and most enterococci.)

Dear Herbert, late-onset sepsis treatment should ideally depend on the microbial flora of your unit and its resistance pattern. In our settings this was clearly distinct between units in different hospitals.

What Ru-Teng describes above would generally probably work, but would fail if you have the bad luck to have a specific resistant strain circulating in your unit. Would it be possible for you to conduct a microbiological survey with some sampling, species and resistance testing?

Hi Herbert, I totally agree with Norbert. Carry out a bacteriologic analysis of the common isolates in your center and their antibiotic susceptibility profiles and tailor your therapy to your findings in the study. Ampicillin has a high rate of resistance in most developing countries including Nigeria. In Jos, Nigeria, we found a resistance of 65% to ampicillin of isolates from our special care baby unit. Gentamicin is still very useful everywhere but not ampicillin. All the best.

We currently use Cefotaxim and Amikacin; However, in the previous institute I worked in - the NICU protocol involved administration of Ciprofloxacin and Netilmicin.

In case of outborn babies, we are finding a disturbing trend wherein small peripheral centers straightaway administer Piperaciilin+ Tazobactum at random, we have tried to communicate and advise them against this practice.

Microbial isolates vary from region to region; best and surest answer is basing your prescription on information and knowledge of microbials in your community at various times. It is also time bound as the pattern may change based on your antibiotic usage. Prescribing based on isolates from other regions is never the best, but good for knowledge on the range of possible isolates in the newborn period. I want to guess that your question may have arisen if you are not getting good result from your prescription pattern or you could not justify the prescription based on cost of the drug, the frequent need to change your antibiotics, the pharmacocology of the drugs being used or the isolates from other centers. If this is it, then do your own review, your centre based study to guide you. In my centre, we started with Ampicillin and Gentamicin but based on further studies with high resistance to Ampicillin, we now use Ceruroxime and Gentamicin or sometimes Ampicillin-sulbactam and Gentamicin and we may not need to change the drug except for nosocomial infections where Ceftazidime, Ciprofloxacillin, Clindamycin, Amikacin, Vancomycin etc may readily be useful either as a single agent or as combined therapy.

It depends on the most common pathogens in the region. We currently use Cefotaxim and Amikacin as first line empirical therapy in neonatal sepsis because most of the isolates of our region are sensitive to cefotaxime or amikacin. In our region there is high resistance to ampicillin and gentamicin both