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Infection/Condition and Likely Organism |
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Congenital and Perinatal Infections |
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Meningitis GBS Escherichia coli Listeria spp. Other Gram-negative bacilli/rod (GNR) |
Empirical therapy. < 1 week of age: Ampicillin 200-300mg/kg/day IV in 3 divided doses >1 week of age: Ampicillin 300mg/kg/day IV in 4 divided doses PLUS Cefotaxime 50mg/kg/ dose IV < 1 week of age: q12h >1 week of age: q8h |
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Necrotising enterocolitis (NEC) Klebsiella spp., Escherichia coli, Clostridia, Coagulase-negative Staphylococci, Enterococci, Bacteroides |
Ampicillin 50mg/kg/dose IV <1 week of age: q12h >1 week of age: q8h PLUS Gentamicin 5mg/kg/dose IV < 30 weeks of CGA: q48h 30-34 weeks of CGA: q36h ≥35 weeks CGA: q24h PLUS Metronidazole IV dose: <34 weeks of age: 7.5mg/ kg/dose IV q12h 35-40 weeks of age: 7.5mg/kg/dose IV q8h >40 weeks of age:10mg/ kg/dose IV q8h |
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Use Vancomycin if CoNS/ MRSA is suspected (substitute Ampicillin with Vancomycin). Duration: 10-14 days. |
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Early onset sepsis (<48 hrs) Group B Streptococcus (GBS), Listeria spp., Streptococcus spp., Escherichia coli, Haemophilus influenzae, Klebsiella spp. etc. |
< 1 week of age: Ampicillin 200-300mg/kg/ day IV in 3 divided doses >1 week of age: Ampicillin 200-300mg/kg/ day IV in 4 divided doses PLUS Gentamicin 5mg/kg/dose IV <30 weeks of CGA: q48h 30-34 weeks of CGA: q36h ≥35 weeks CGA: q24h |
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If negative blood culture, initial clinical suspicion not strong and reassuring baby’s condition with low CRP, consider stopping antibiotics at 48 hours. If positive blood culture or strong clinical suspicion of sepsis but negative culture, may give 5-7 days of antibiotics. Consider antibiotics for more than 5-7 days if baby not fully recovered and based on pathogen identified on blood culture. In this empiric therapy - meningitis is not a consideration. |
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Late onset sepsis >48 hours MSSA/MRSA, Coagulase- negative Staphylococci (CoNS), Gram-negative rods |
First line: (Flu)cloxacillin 50mg/kg/ dose IV <1 week of age: q12h >1 week of age: q8h OR Cefotaxime 50mg/kg/dose IV <1 week of age: q12h >1 week of age: q8h
PLUS Gentamicin 5mg/kg/dose IV < 30 weeks of CGA: q48h 30-34 weeks of CGA: q36h ≥35 weeks of CGA: q24h |
Second line: Piperacillin-tazobactam IV PMA < 30 weeks: 100mg/kg/dose q8h PMA > 30 weeks: 80mg/ kg/dose q6h Other options: Cefepime GA < 36 weeks: 30mg/kg/ dose q12h GA ≥ 36 weeks: 50mg/kg/ dose q12h OR Meropenem GA <32 weeks: 20mg/kg/ dose IV PNA < 14 days: q12h PNA ≥ 14 days: q8h
GA ≥ 32 weeks: PNA < 14 days: 20mg/kg/ dose IV q8h PNA ≥ 14 days: 30mg/kg/ dose IV q8h OR Imipenem-cilastatin 25mg/kg/dose IV PNA < 1 week: q12h PNA ≥ 1 week q8h |
Piperacillin-tazobactam is a good second line option in pneumonia and intra abdominal sepsis (non-CONS sepsis with good coverage against Gram-positive, Gram-negative and anaerobes) |
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Congenital syphilis Treponena pallidum |
Benzylpenicillin (Penicillin G) 50,000 units/kg/dose IV for first 7 days of life: q12h thereafter: q8h Duration: 10 days If diagnosed with congenital syphilis after one month of age: Benzylpenicillin (Penicillin G): 200,000-300,000units/kg/ day IV in 4-6 divided doses for 10-14 days. |
Benzathine penicillin G 50,000 Unit/kg/dose single dose IM |
In infants considered less likely to have syphilis and normal CSF examination including normal physical examination and long bone radiograph: Benzathine penicillin G 50,000units/kg/dose IM in a single dose can be given. |
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Congenital toxoplasmosis Toxoplasma gondii |
Pyrimethamine-sulfadoxine Pyrimethamine (1.25mg/kg/dose PO every 10 days) PLUS Sulfadoxine (25mg/kg/dose PO every 10 days) PLUS Folinic acid 50mg PO every 7 days for 12 months |
Pyrimethamine 1mg/ kg/day PO for 2 months, followed by 0.5mg/kg/day PO for 10 months PLUS Sulfadiazine 100mg/kg/ day PO in 2 divided doses for 12 months PLUS Folinic Acid 50mg PO every 7 days for 12 months |
Prednisolone 0.5mg/kg (max. 20mg/dose) q12h can be added if CSF protein ≥ 1g/dL or active severe chorioretinitis. Steroids given till CSF protein <1g/dL or resolution of severe chorioretinitis. |
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Herpes simplex Neonatal Localised skin, eye and mouth (SEM) Central nervous system (CNS) with or without SEM Disseminated disease involving multiple organs |
Acyclovir 60mg/kg/day IV in 3 divided doses All infants surviving neonatal HSV infection of any classification should receive oral acyclovir suppression at 300mg/m2/ dose administered 3 times daily for 6 months after completion of parenteral therapy. |
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Duration: SEM: 14 days CNS/disseminated: ≥ 21 days For CNS disease: Repeat lumbar puncture at end of therapy for HSV PCR. If PCR remains positive, continue IV acyclovir for another one week. |
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Tetanus neonatorum Clostridium tetani |
Metronidazole PMA ≤ 34 weeks: 7.5mg/ kg/dose IV q12h PMA 35-40 weeks: 7.5mg/ kg/dose IV q8h PMA >40 weeks: 10mg/kg/ dose IV q8h |
Benzylpenicillin (Penicillin G) GA<34 weeks: 100,000units/kg/dose IV postnatal age <7 days: q12h postnatal age > 7 days: q8h
GA >34 weeks: 100,000units/kg/dose IV postnatal age <7 days: q8h postnatal age > 7 days: q6h |
Duration : 10 days. |
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Congenital gonococcal ophthalmitis /conjunctivitis |
Immediate and frequent saline eye irrigation. Non-disseminated disease: Cefotaxime 100mg/kg/dose IV in a single dose. May need to continue for 48-72 hours until systemic infection has been ruled out Disseminated disease: Cefotaxime 50mg/kg/dose IV < 1 week of age: q12h > 1 week of age: q8h |
If penicillin-susceptible: Benzylpenicillin GA <34 weeks: 100,000units/kg/dose IV postnatal age <7 days: q12h postnatal age >7 days: q8h
GA >34 weeks: 100,000units/kg/dose IV postnatal age <7 days: q8h postnatal age >7 days: q6h |
For 7 days, with a duration of 10-14 days, if meningitis is documented. Evaluate for signs of disseminated infection (e.g. sepsis, arthritis and meningitis). Screen mother and baby for chlamydial infection. Screen for other STDs. Investigate and treat parents. |
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Chlamydia trachomatis conjunctivitis |
Erythromycin ethylsuccinate 10mg/kg/dose PO <1 week of age: q12h >1 week of age: q8h |
Azithromycin 20mg/kg/ day PO, once daily for 3 days. |
Duration: 14 days. Local eye toilet until discharge stops Re-swab after treatment; 20-30% will need a second course to clear infection. |
NEONATAL INFECTIONS
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Infection/Condition and Likely Organism |
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GBS Streptococcus agalactiae |
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Sepsis |
< 1 week of age: Ampicillin 200-300mg/kg/day IV in 3 divided doses >1 week of age: Ampicillin 300mg/kg/day IV in 4 divided doses PLUS Gentamicin 5mg/kg/dose IV < 30 weeks of CGA: q48h > 30-34 weeks of CGA: q36h ≥35 weeks of CGA: q24h |
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Duration of treatment for GBS: Uncomplicated: 14 days (Bacteremia without a defined focus). Meningitis: 21 days. Gentamicin can be discontinued once the infection is under control. |
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Meningitis |
Ampicillin <1 week of age: 200-300mg/kg/day IV in 3 divided doses >1 week of age: 300mg/kg/day IV in 4 divided doses PLUS Gentamicin 5mg/kg/dose IV < 30 weeks of CGA: q48h >30-34 weeks of CGA: q36h ≥ 35 weeks CGA: q24h |
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Duration for treatment. Meningitis: 21 days. Doses of penicillin for meningitis is higher as recommended by experts (as high as 500,000 unit/ kg/day (> 7 days of age). |
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Escherichia coli Sepsis/Meningitis |
Cefotaxime 50mg/kg/dose IV < 1 week of age: q12h > 1 week of age: q8h Cefotaxime 50mg/kg/dose IV GA<32weeks PNA < 14 days: q12h PNA ≥ 14 days: q8h
GA ≥32 weeks PNA ≤7 days: q12h PNA >7 days: q8h
PLUS Gentamicin 5mg/kg/dose IV < 30 weeks of CGA: q48h > 30-34 weeks of CGA: q36h ≥ 35 weeks CGA: q24h |
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Duration in bacteremia: 14 days. Duration for meningitis: 21 days. All cases of bacteremia need lumbar puncture to exclude meningitis. |