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Early Empiric Antibiotic De-escalation in Suspected Early Onset Neonatal Sepsis

Author(s): N. A. Ibrahim, M. Makmor Bakry, K. C. See1, N. A. Mohd. Tahir and N. Mohamed Shah*
Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, 1Department of Pediatrics, Hospital Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia

Correspondence Address:
Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia, E-mail:

Neonates in the intensive care unit diagnosed with suspected early onset neonatal sepsis are common. Empiric antibiotic therapy is crucial for the management of early onset neonatal sepsis. The purpose of this study was to describe the empiric antibiotic de-escalation practice in suspected early onset neonatal sepsis and evaluate its outcome within 7 days of birth. This was a single centre study conducted at a Malaysian tertiary hospital where new-borns were admitted to the hospital within 72 h of birth and prescribed with an empiric antibiotic therapy were included. Relevant data were retrieved from the patients’ electronic medical records. A total of 529 new-borns were screened and 278 (mean gestational age- 34.9±3.73 weeks, birth weight- 2.34±0.87 kg) were included. Common maternal risk factors of early onset neonatal sepsis identified were prolonged rupture of membranes (>18 h), positive culture of the maternal high vaginal swab and meconium-stained amniotic fluid. Majority of patients presented with respiratory symptoms and empiric antibiotics, namely crystalline penicillin and gentamicin were started within 24 h of birth. The early empirical antibiotic de-escalation was practiced in 98.5 % of patients; of these, 59 % had aminoglycoside withdrawal after the second dose and continuation of crystalline penicillin as a monotherapy (de-escalation group I). The remaining patients had complete antibiotic withdrawal prior to 72 h of exposure (de-escalation group II). New-borns in the de-escalation group I had significantly longer treatment duration and poor Apgar scores at 1 min of life (Apgar score ≤3; p<0.05). In addition, 6 patients had positive blood cultures and 2.2 % of patients were classified as treatment failure. Hence, an early antibiotic de-escalation may potentially be practiced in suspected early onset neonatal sepsis.

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