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Ever since a series of case reports of anaerobic bacteraemia in the late 1970s and early 1980s, there has been a perception among neonatal paediatricians that babies must be ‘covered’ for anaerobes under all sorts of circumstances: smelly placentas, abdominal surgery, necrotising enterocolitis for example. Anaerobophobia is a condition largely confined to doctors, and is endemic among neonatologists. In fact standard antibiotic combinations cover most important anaerobes, with the exception of Bacteroides fragilis. This organism is covered by metronidazole, which is widely prescribed even though it has well known neurotoxicity and has never been evaluated in a randomised controlled trial. Gross et al (Acta Paediatrica, doi:10.1111/apa.14262) have now quantified what many people have long suspected: anaerobic bacteraemia is actually very rare in the neonate. Although the thrust of their paper was to question the use of anaerobic blood culture bottles, it is the implications for antibiotic choice that Hyperion finds more interesting.
Outcomes for sick term babies
We know a lot about what happens to very preterm babies in the long run, but rather less about those term babies who have the misfortune to encounter a ‘severe’ neonatal …