Antibiotic treatment for neonatal sepsis: changing trends and future directions

Neonatal sepsis is a serious and life-threatening condition with high morbidity and mortality, especially in preterm neonates in a Neonatal Intensive Care Unit (NICU). This article provides an updated review on the aetiology and diagnosis of neonatal sepsis, antibiotic management and antibiotic stewardship.

A literature search was conducted in PubMed, Embase, Cochrane Library and Scopus in January 2025, using the following MeSH terms: "sepsis", "neonate" and "antibiotic". Meta-analyses, randomized controlled trials, clinical trials and reviews published in the English language from 2005 to 2025 with patients in the neonatal age group were included. A total of 715 articles were identified and screened, and 85 studies were included in the final review.

Neonatal sepsis remains a leading cause of mortality, with distinct pathogens identified in early-onset and late-onset sepsis, ventilator-associated pneumonia, urinary tract infection and fungal infections. Early recognition, accurate diagnosis and timely commencement of empirical antibiotics are paramount for improved outcomes. Fungal prophylaxis is considered for at-risk neonates in some NICUs with a high incidence of fungal infection. Universal group B Streptococcus screening decreased the incidence of early onset sepsis, but the emergence of resistant strains of certain organisms present new challenges. Evidence-based antibiotic prescription guidelines, antibiotic stewardship programmes and quality improvement projects are essential for the prevention of antimicrobial resistance in the NICU.

Effective management of neonatal sepsis relies on early pathogen identification, judicious use of antibiotics and good antimicrobial stewardship. Future research directions include development of evidence-based protocols and improvement of rapid diagnostic techniques, combined with close monitoring and individualized care.