Antibiotics for late-onset neonatal sepsis
Late-onset neonatal sepsis (LOS) is defined as neonatal sepsis occurring after the first 72 hours to 1 month of life.
Causative organisms differ from EOS and vary widely among units. In developed countries, coagulase-negative staphylococci are the leading cause, followed by GBS and gram-negative bacteria.
Treatment options for causative organisms include:
• Coagulase-negative staphylococci: vancomycin
• GBS, Escherichia coli, enterococci: cefotaxime or piperacillin/tazobactam
• Gram-negative bacteria (e.g., Klebsiella): gentamicin
• Pseudomonas: ceftazidime or piperacillin/tazobactam
• Listeria monocytogenes: ampicillin
• Anaerobic bacteria (e.g., in necrotising enterocolitis): metronidazole or clindamycin
Examples of suitable empirical antibiotic regimens include ampicillin plus gentamicin or cefotaxime, or vancomycin plus gentamicin or cefotaxime. Ceftazidime or piperacillin/tazobactam may be added to the empirical regimen if Pseudomonas is suspected. Metronidazole or clindamycin may be added to the empirical regimen to cover for anaerobes/necrotising enterocolitis.