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Rationing antibiotic use in neonatal units
  1. DAVID ISAACS
  1. New Children's Hospital
  2. PO Box 3515
  3. Parramatta
  4. NSW 2124
  5. Australia
  6. davidi@nch.edu.au

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Late onset sepsis

In Oxford in 1987 penicillin G and gentamicin were being used to treat babies with suspected early onset sepsis (within 48 hours of birth), and flucloxacillin and gentamicin to treat suspected late onset sepsis.1 The organisms responsible for early onset sepsis have changed very little since then,2 3 with group B streptococci and Escherichia coli still the major causative organisms, and penicillin G or ampicillin, together with an aminoglycoside, still appropriate empiric treatment for suspected early onset infection.

In contrast, the organisms responsible for late sepsis have changed. The most commonly isolated organisms from babies with late onset sepsis, responsible for 50% or more episodes of systemic sepsis in Australia,4 the USA,5 Britain6and many other countries, are now coagulase negative staphylococci. Most of these—over 90% of those cultured in Australia—are methicillin resistant.4 Only half of the isolates of coagulase negative staphylococci in Australia are associated with the presence of a central silastic intravascular cannula.4

Vancomycin and vancomycin resistant organisms

As a result of the increase in staphylococcal infections, many neonatal units in Australia and the United Kingdom use vancomycin as part of their first line empiric treatment for suspected late onset sepsis. Vancomycin is a glycopeptide antibiotic, originally introduced in the 1960s, which lost favour because of perceived toxicity, but was re-introduced because it is active against methicillin resistant strains of Staphylococcus aureus (MRSA) and coagulase negative staphylococci. Vancomycin is active against most Gram positive organisms, but not against Gram negative organisms or anaerobes.

The emergence of Gram positive organisms which …

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