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Choosing the right empirical antibiotics for neonates
  1. P Brian Smith1,2,
  2. Daniel K Benjamin Jr1,2
  1. 1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Duke Clinical Research Institute, Durham, North Carolina, USA
  1. Correspondence to Dr P Brian Smith, Duke Clinical Research Institute, Box 17969, Durham, NC 27715, USA; brian.smith{at}

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Muller-Pebody et al1 provide a description of antibiotic sensitivitiesdetected in a large number of bacterial isolates from neonatal blood cultures. The Health Protection Agency's voluntary surveillance scheme captures microbiology results from 90% of the laboratories in England and Wales, a strength of this study. The study defined early-onset sepsis as a positive blood culture in the first 48 h of life and late-onset sepsis as a positive blood culture obtained between days 2 and 28 of life. From January 2006 to March 2008, 1516 bacteria were isolated from neonates in the first 48 h of life and 3482 bacteria were isolated from neonates 2–28 days of age.

Gram-positive organisms composed 82.2% of early-onset sepsis isolates and 80.7% of late-onset sepsis isolates. Nearly all (94%) of the early-onset isolates were sensitive to an antibiotic regimen of penicillin+gentamicin and 100% were sensitive to the combination of amoxicillin+cefotaxime. For late-onset isolates, 93% were sensitive to amoxicillin+cefotaxime and 96% were sensitive to a regimen of amoxicillin+gentamicin. Excluding coagulase negative staphylococci (CoNS) from the analysis, the authors continued to observed high rates of sensitivity (95–97%) of the remaining isolates to relatively narrow spectrum antibiotic regimens including penicillin+gentamicin and flucloxacillin+gentamicin. The …

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  • Funding NIH.

  • Competing interests PBS received support from NICHD 1K23HD060040-01 and from industry for neonatal and paediatric drug development ( DKB receives support from the US Government for his work in paediatric and neonatal clinical pharmacology (1R01HD057956-02, 1R01FD003519-01, 1U10-HD45962-06, 1K24HD058735-01, HHSN267200700051C), the non-profit organisation Thrasher Research Foundation for his work in neonatal candidiasis (, and from industry for neonatal and paediatric drug development (

  • Provenance and peer review Commissioned; internally peer reviewed.