Antibiotic use and misuse in the neonatal intensive care unit

Neonatal sepsis causes significant morbidity and mortality, especially in preterm infants. Clinicians are compelled to treat with empiric antibiotics at the first signs of suspected sepsis. Broad-spectrum antibiotics and prolonged treatment with empiric antibiotics are associated with adverse outcomes. Most common neonatal pathogens are susceptible to narrow-spectrum antibiotics. The choice of antibiotic and duration of empiric treatment are strongly associated with center-based risk factors. Clinicians should treat with short courses of narrow-spectrum antibiotics whenever possible, choosing the antibiotics and treatment duration to balance the risks of potentially untreated sepsis against the adverse effects of treatment in infants with sterile cultures.