Getting the bug

In this issue there are three papers on infection and an editorial on the issue of empirical antibiotic treatment. A letter that complements the editorial was published in November1. With NICE turning its attention towards the management of infection in neonates, these papers come at an opportune moment and I hope they will stimulate much debate. Muller-Pebody et al use data from the Health Protection Agency (HPA) that covered the whole of England and Wales for over two years, but limited the analysis to infants under 28 days. They sought retrospectively to ascertain whether current empirical treatment guidelines are adequate, and the answer is broadly that they are, although regimes relying on the broad spectrum of cefotaxime might best be avoided. However, this is the very reason for the note of dissent in Millar's letter. There is clearly going to be a trade-off between the degree of ‘blind’ cover for organisms, and other unwanted consequences of ecological exposure to cephalosporins. The trouble is neither this nor the following paper can shed any light on …