Antibiotics for Neonatal Sepsis


Reviewed by Clinical Practice Committee
September 2016
Clinical Guidelines Back Newborn Services Home Page
Classification Risk factors for Sepsis Signs of Sepsis Investigations
  Antibiotic Use Duration of Treatment  

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

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.

Early onset infection: LP is indicated if the organism is Group B strep or E coli or if infant severely unwell.

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