Pediatric Guidelines: Severe Sepsis - Hospitalized Neonate

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Severe sepsis, neonate 0-7 days old during birth hospitalization (ICN/Pedi-Med, has not gone home)

Click here for guidelines on empiric therapy for neonates admitted from home with severe sepsis

Enteric Gram negatives

Group B streptococcus

Less Common:

Listeria monocytogenes

Gentamicin

AND

Ampicillin

Consider:

Acyclovir for infants > 48h of life with ongoing sepsis and unexplained thrombocytopenia or hepatitis

Cefotaxime is preferred in place of Gentamicin in neonates with impaired renal function, persistent hypotension, or high suspicion for meningitis

Refer to Neonatal Dosing Guideline for antibiotic doses and intervals

ID consult recommended if not responsive to empiric regimen

Severe sepsis, infant > 7 days old during birth hospitalization (ICN) 

Coagulase-negative staphylococci

Staphylococcus aureus

Gram negatives, including Enterobacter, other MDR organisms 

Enterococcus spp

Candida spp

 

Gentamicin

AND

Vancomycin 

ADD:

Acyclovir if infant has cutaneous vesicles, seizure, CSF pleocytosis, thrombocytopenia or hepatitis

ADD: 

Metronidazole for suspected necrotizing enterocolitis* or other intra-abdominal infection (unless patient on other agent with anaerobic activity such as Piperacillin-tazobactam or Meropenem)

Cefotaxime is preferred in place of Gentamicin in neonates with impaired renal function, persistent hypotension, or high suspicion for meningitis

Refer to Neonatal Dosing Guideline for antibiotic doses and intervals

ID consult recommended if not responsive to empiric regimen

If treating empirically without organism isolated at 48+ hours, consider change to Ampicillin and Gentamicin for remainder of empiric course (see above Neonate 0-7 Days regimen)

*Click here for guidance on antibiotic selection and duration of therapy for Necrotizing Enterocolitis 

 

 

If patient develops sepsis while on antibiotics or does not respond to initial regimen within 24h: 

CHANGE Gentamicin to Meropenem

AND

ADD Fluconazole

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).