Antibiotic stewardship: reassessment of guidelines for management of neonatal sepsis

Area of Science:

• Neonatal Medicine
• Infectious Disease Prevention
• Pediatric Guidelines

Background:

• The Centers for Disease Control and Prevention (CDC) issued guidelines in 2010 for preventing perinatal group B streptococcus disease.
• The American Academy of Pediatrics' Committee on the Fetus and Newborn (COFN) published a report in 2012 suggesting increased empirical antibiotic use for infants with early-onset sepsis (EOS) risk factors, exceeding CDC recommendations.

Purpose of the Study:

• To review the 2010 CDC guidelines and the 2012 COFN report on preventing perinatal group B streptococcus disease.
• To summarize COFN's 2014 commentary and revised clinical algorithm for managing infants at risk for EOS.
• To discuss strategies for minimizing empirical antibiotic administration in well-appearing term infants.

Main Methods:

• Literature review of CDC and COFN publications.
• Analysis of clinical recommendations and algorithms.
• Discussion of potential interventions to reduce antibiotic use.

Main Results:

• The article contrasts the 2010 CDC guidelines with the 2012 COFN report's approach to EOS risk.
• It presents a revised clinical algorithm from COFN's 2014 commentary.
• It explores methods to decrease unnecessary antibiotic exposure in neonates.

Conclusions:

• There is a need to reconcile differing recommendations regarding empirical antibiotic use for neonatal sepsis.
• Revised clinical algorithms aim to optimize management of infants at risk for EOS.
• Strategies are needed to reduce the number of healthy infants receiving empirical antibiotics.