Antibiotics for Neonatal Sepsis


Reviewed by Carl Kuschel
Clinical Guidelines Back Newborn Services Home Page
Classification Indications for Antibiotics Risk factors for Sepsis Signs of Sepsis
Investigations Antibiotic Use Duration of Treatment References

* Figures for blood stream infections within NICU at NWH 1998.

Classification of Neonatal Sepsis

Early Onset Sepsis
(infection occurring in the first 5 days of life)
Late Onset Sepsis
(infection occurring after 5 days of age)
Exposure to bacteria can occur:
  • Before delivery due to infected amniotic fluid or occasionally following maternal sepsis
  • During delivery when contact with organisms in the vagina can occur
  • After delivery following exposure to organisms in the infants environment
Usually due to:
  • Nosocomial infection, organisms acquired from the environment
  • Coagulase negative Staphylococci are the most common causative organisms
  • VLBW infants with indwelling catheters, central lines, chest drains etc are at particular risk

When should Antibiotics be Given?

Risk Factors for Sepsis

Signs of Sepsis in the Newborn

What Investigations Should be Performed?

The following investigations may need to be considered depending on the organism isolated.

Late onset sepsis:  In addition to the above consider

Antibiotic Use in Suspected Sepsis

First five days

After first five days

Start amoxycillin and gentamicin for all neonates.

Start flucloxacillin and amikacin in all babies

  • Almost all Coag negative Staphylococcus is sensitive to amikacin but resistant to gentamicin.
  • Flucloxacillin is used at present because of an increased number of Staphylococcus aureus isolates within the unit.

Add amoxycillin if specific cover for Enterococci, Strep fecaelis (suspected NEC), Listeria or Group B Streptococcus is needed.

Duration of Treatment

Infection type

Duration (days) of therapy





Urinary Tract Infection



(depending on organism isolated)

Skin conditions




Oral thrush



1 Neonatal sepsis and meningitis. Philip AGS. GK Hall Medical Publishers. Boston 1985. ISBN 0-8161-2253-9.
2 Neonatal Sepsis; progress in diagnosis and management. St Geme III JW. Polin RA. New Ethicals 1989; 25(6); 133-41(part 1) and 25(7); 109-31(part 2).