Kuppala et al evaluated preterm infants who received empiric antibiotic treatment to prevent early onset sepsis secondary to an intra-uterine infection. The authors are from Cincinnati Children's Hospital.


Patient selection: gestational age <= 32 weeks with birth weight <= 1,500 grams, surviving 7 days free of sepsis and necrotizing enterocolitis


Antibiotic therapy was prolonged if it was given for >= 5 days.


Complications of prolonged antibiotic therapy:

(1) late onset neonatal sepsis (LOS)

(2) necrotizing enterocolitis

(3) death


The odds ratio for a complication in a patient receiving prolonged antibiotic therapy was about 2.5.


Empiric antibiotic therapy is reasonable in this patient population but should not be prolonged if:

(1) cultures are negative with adequate sampling OR no clinical suspicion of sepsis if inadequate sampling performed

(2) the neonate is otherwise at low risk for sepsis


Additional complications may include:

(1) increased risk of infection with an antibiotic resistant bacteria or fungus

(2) antibiotic-associated toxicity


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