Neonatal Pneumonia: Comparison of 4 vs 7 Days of Antibiotic Therapy in Term and Near-Term Infants

Abstract

Four days of antibiotic therapy plus a 24-hour period of observation for selected cases of neonatal pneumonia appears to be comparable to 7 days of therapy. It is important to note that newborns in our institution receive a single dose of penicillin soon after birth as part of our group B streptococcal sepsis prophylaxis program, and all infants in this study received prophylaxis prior to the onset of respiratory symptoms. Furthermore, only infants who were asymptomatic after 48 hours of antibiotic therapy were included in this study, and a 24-hour observation period at the end of the 4-day course was required. These qualifications should be taken into account before use of this approach is considered, and additional studies are necessary to further establish its safety and benefits.

Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

“…These studies either documented no patients with bacteremia [30,31] or did not report on this subgroup [32-34]. …”

Usefulness of Two Clinical Chorioamnionitis Definitions in Predicting Neonatal Infectious Outcomes: A Systematic Review

“…5 Jackson et al demonstrated that stable newborns with gestational age of at least 35 weeks and birth weight of at least 2,100 g, not requiring cardiorespiratory monitoring or respiratory support, could be admitted for intramuscular antibiotic treatment and monitoring to the normal newborn nursery and do not necessarily require transfer to a more intensive level of care. 18,[32][33][34] Neonatal antibiotics regime should be narrowed to target the specific pathogen once identified and should be discontinued when results of work-up for neonatal sepsis (e.g., negative C-reactive protein and/or serial blood cell counts) become available in culture negative neonates.…”

Choice and Duration of Antimicrobial Therapy for Neonatal Sepsis and Meningitis

“…In the chapter on bacterial sepsis and meningitis, Klein recommend 10 days of therapy for culture-proven sepsis with minimal or absent focal infection [22]. However, there is a paucity of RCTs evaluating the rationale and safety of the appropriate duration of therapy [53–55]. Table 2 describes the RCTs evaluating shorter versus longer courses of antibiotic therapy in neonatal pneumonia and culture-proven sepsis.…”

“…Engle et al [53] randomized cases of neonatal pneumonia to either 4-day or 7-day course of antibiotics. Randomization was done on day 4 of antibiotic therapy if the infants were completely asymptomatic for at least 48 hours.…”