Overview of Neonatal Infections: Infections in Neonates: Merck Manual Professional

In This Topic

Pediatrics
	Infections in Neonates
		Overview of Neonatal Infections
				Risk factors
			Symptoms and Signs
			Diagnosis
			Treatment

Resources

Overview of Neonatal Infections

Share This

Neonatal infection can be acquired in utero transplacentally, through the birth canal during delivery (intrapartum), and from external sources after birth (postpartum).

In utero infection, which can occur any time before birth, results from overt or subclinical maternal infection. Consequences depend on the agent and timing of infection in gestation and include spontaneous abortion, intrauterine growth restriction, premature birth, stillbirth, congenital malformation (eg, rubella), and symptomatic neonatal infection (eg, cytomegalovirus [CMV], toxoplasmosis, syphilis).

Common viral agents include herpes simplex, HIV, CMV, and hepatitis B. Intrapartum infection with HIV or hepatitis B occurs from passage through an infected birth canal or by ascending infection if delivery is delayed after rupture of membranes; these viruses can less commonly be transmitted transplacentally. CMV is commonly transmitted transplacentally. Bacterial agents include group B streptococci, enteric gram-negative organisms (primarily Escherichia coli), gonococci, and chlamydiae.

Postpartum infections are acquired from contact with an infected mother either directly (eg, TB, which also is sometimes transmitted in utero) or through breastfeeding (eg, HIV, CMV) or from contact with health care practitioners and the hospital environment (numerous organisms—see Infections in Neonates: Neonatal Hospital-Acquired Infection).

Risk factors: Risk of contracting intrapartum and postpartum infection is inversely proportional to gestational age. Neonates are immunologically immature, with decreased polymorphonuclear leukocyte and monocyte function; premature infants are particularly so (see also Perinatal Physiology: Immunologic function). Maternal IgG antibodies are actively transported across the placenta, but effective levels for all organisms are not achieved until near term. IgM antibodies do not cross the placenta. Premature infants have decreased intrinsic antibody production and reduced complement activity. Premature infants are also more likely to require invasive procedures (eg, endotracheal intubation, prolonged IV access) that predispose to infection.

Symptoms and Signs

Symptoms and signs in neonates tend to be nonspecific (eg, vomiting, fever, petechiae, rashes, diarrhea, fever, hypothermia). Many congenital infections acquired before birth can cause or be accompanied by various symptoms or abnormalities (eg, growth restriction, deafness, microcephaly, anomalies, failure to thrive, hepatosplenomegaly, neurologic abnormalities).

Diagnosis

A wide variety of infections should be considered in neonates who are ill, febrile, or hypothermic. Infections such as congenital rubella, syphilis, toxoplasmosis, and CMV should be considered, particularly in neonates with abnormalities such as growth restriction, deafness, microcephaly, anomalies, failure to thrive, hepatosplenomegaly, or neurologic abnormalities.

Treatment

Antimicrobial therapy

The primary treatment is usually antimicrobial therapy. Drug selection is similar to that in adults, because infecting organisms and their sensitivities are not specific to neonates. However, numerous factors, including age and weight, affect dose and frequency (see Table 1: Infections in Neonates: Recommended Dosages of Selected Parenteral Antibiotics for Neonates and Table 2: Infections in Neonates: Recommended Dosages of Selected Oral Antibiotics for Neonates*).

Table 1

Print Open table in new window

Recommended Dosages of Selected Parenteral Antibiotics for Neonates
			Interval of Administration
Antibiotic	Route of Administration	Individual Dose	Body Weight < 1200 g		Body Weight 1200 – 1999 g		Body Weight ≥ 2000 g
			Age		Age		Age
			≤ 7 days	8–28 days	0–7 days	≥ 8 days	0–7 days	≥ 8 days	Comments
AmikacinSome Trade Names AMIKIN Click for Drug Monograph *	IV, IM	7.5–10 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 8 h	q 12 h	q 8 h	Monitoring of serum drug levels required (peak = 20–30 μg/mL; trough = < 10 μg/mL) Dose reduction required for impaired renal function For term neonates, may be given as a single dose of 15–20 mg/kg/day
Amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph	IV	0.25–1 mg/kg	After dilution in 5% or 10% D/W (saline solution should not be used), infusion of a test dose of 0.1 mg/kg (maximum 1 mg) over 1 h to assess patient's febrile and hemodynamic response;^† if no serious adverse effects are observed, infusion of a therapeutic dose (usually 0.25–1.25 mg/kg over 2–4 h), which may be given the same day as the test dose After the patient improves, may give the dose every other day until therapy is complete Monitoring of K levels and hematologic and renal functions required
AmpicillinSome Trade Names OMNIPEN PRINCIPEN Click for Drug Monograph For meningitis	IV	50 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	IV as 15– to 30-min infusion (≤ 10 mg/kg/min)
For other diseases	IV, IM	25 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h
AztreonamSome Trade Names AZACTAM Click for Drug Monograph	IV, IM	30 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	Limited data For gram-negative bacilli only
CefazolinSome Trade Names ANCEF KEFZOL Click for Drug Monograph ^‡	IV, IM	20 mg/kg	q 12 h	q 12 h	q 12 h	q 12 h	q 12 h	q 8 h	Limited data No primary indication; not used as initial therapy for sepsis or meningitis
CefepimeSome Trade Names MAXIPIME Click for Drug Monograph	IV, IM	30 mg/kg	q 12 h	q 12 h until age 14 days	q 12 h	q 12 h until age 14 days	q 12 h	q 12 h until age 14 days	May be used for Pseudomonas aeruginosa infections Sometimes used for meningitis, although usually as a 2nd-line drug and not always recommended
CefepimeSome Trade Names MAXIPIME Click for Drug Monograph	IV, IM	50 mg/kg	—	q 8–12 h if age > 14 days	—	q 8–12 h if age > 14 days	—	q 8–12 h if age > 14 days
CefotaximeSome Trade Names CLAFORAN Click for Drug Monograph	IV, IM	50 mg/kg	q 12 h	q 8–12 h	q 12 h	q 8 h	q 8–12 h	q 6–8 h	Often a first-line therapy for neonatal meningitis
CeftazidimeSome Trade Names FORTAZ TAZICEF Click for Drug Monograph	IV, IM	50 mg/kg	q 12 h	q 8 h	q 12 h	q 8 h	q 8 h	q 8 h	Penetrates well into inflamed meninges 70–90% of drug excreted unchanged in urine
CeftriaxoneSome Trade Names ROCEPHIN Click for Drug Monograph	IV, IM	25–50 mg/kg	q 24–36 h	q 24–36 h	q 24 h	q 24 h	q 24 h	q 24 h	Limited data May cause biliary pseudolithiasis and, in jaundiced premature infants, may increase risk of bilirubin encephalopathy via displacement of bilirubin from albumin Contraindicated for 48 h after the infusion of Ca-containing solutions in infants ≤ 28 days For meningitis, 40–50 mg/kg q 12 h or 80–100 mg/kg q 24 h
ChloramphenicolSome Trade Names CHLOROMYCETIN Click for Drug Monograph	IV	25 mg/kg	q 24 h	q 24 h	q 24 h	q 24 h	q 24 h	q 12 h	Doses adjusted by monitoring serum drug levels and hematologic parameters For meningitis, desired peak serum levels = 15–25 μg/mL and trough levels = 5–15 μg/mL For other infections, dose adjusted to attain a peak level of 10–20 μg/mL and a trough level of 5–10 μg/mL Large variability in serum levels and serum half life, especially in preterm neonates
ClindamycinSome Trade Names CLEOCIN Click for Drug Monograph	IV, IM	5 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	For anaerobes and gram-positive cocci (not enterococci)
GentamicinSome Trade Names GARAMYCIN Click for Drug Monograph *	IV, IM	2.5 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 8–12 h	q 12 h	q 8 h	Monitoring of serum drug levels required (peak = 4–12 μg/mL; trough = 0.5–2 μg/mL) Dose reduction required for impaired renal function Reduction in frequency (to q 18–24 h) for very small, premature infants For term infants, possibly gentamicinSome Trade Names GARAMYCIN Click for Drug Monograph 4 mg/kg q 24 h (peak serum levels are 2–3 times higher)
Imipenem	IV	20–25 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 12 h	q 12 h	q 8 h	Limited data
KanamycinSome Trade Names KANTREX Click for Drug Monograph *	IV, IM	7.5–10 mg/kg	q 18–24 h	q 18–24 h	q 12–18 h	q 8–12 h	q 12 h	q 8 h	Monitoring of serum drug levels required (peak = 20–30 μg/mL; trough serum level should be < 10 μg/mL) Dose reduction required for impaired renal function Reduction in frequency (to q 18–24 h) required for very small, premature infants
MetronidazoleSome Trade Names FLAGYL Click for Drug Monograph	IV	7.5 mg/kg	q 24–48 h	q 24–48 h	q 24 h	q 12 h	q 12 h	15 mg q 12 h	Limited data Loading dose of 15 mg/kg, then a subsequent dose 48 h later in preterm infants and 24 h later in term infants and then q 12 h
NafcillinSome Trade Names UNIPEN Click for Drug Monograph For meningitis or endocarditis	IV	50 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	Monitoring of CBC and liver function required Primarily excreted via the biliary tract In jaundiced neonates, possible accumulation in serum, which may have adverse effects
For other diseases	IV, IM	25 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	—
For other diseases	IV, IM	37.5 mg/kg	—	—	—	—	—	q 6 h
OxacillinSome Trade Names BACTOCILL PROSTAPHLIN Click for Drug Monograph For meningitis or endocarditis	IV	50 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h
For other diseases	IV, IM	25 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	—
For other diseases	IV, IM	37.5 mg/kg	—	—	—	—	—	q 6 h
Penicillin GSome Trade Names BICILLIN WYCILLIN Click for Drug Monograph , aqueous For meningitis	IV	50,000–75,000 units/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	Maximum for group B streptococcal meningitis = 500,000 units/kg/day
For most other diseases	IV, IM	25,000 units/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h
Penicillin GSome Trade Names BICILLIN WYCILLIN Click for Drug Monograph , procaine	IM	50,000 units/kg	Not recommended	Not recommended	q 24 h	q 24 h	q 24 h	q 24 h	Caution: Sterile abscess and procaine toxicity
Piperacillin/TazobactamSome Trade Names ZOSYN	IV (dose based on piperacillinSome Trade Names PIPRACIL Click for Drug Monograph component)	50 mg/kg	q 12 h	—	q 12 h	—	—	—	May be increased to 100 mg/kg q 6 h in infants > 28 days
Piperacillin/TazobactamSome Trade Names ZOSYN		100 mg/kg	—	q 8 h	—	q 8 h	q 12 h	q 8 h
TobramycinSome Trade Names NEBCIN TOBI TOBREX Click for Drug Monograph *	IV, IM	2.5 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 8–12 h	q 12 h	q 8 h	Monitoring of serum drug levels (peak = 4–12 μg/mL; trough serum level should be < 2 μg/mL) Dose reduction required for impaired renal function Reduction in frequency (to q 18–24 h) required for very small, premature infants For term neonates, may be given as 4 mg/kg once/day (peak serum levels are 2–4 times higher with once/day dosing)
VancomycinSome Trade Names VANCOCIN Click for Drug Monograph	IV	10–15 mg/kg	q 24 h	q 24 h	q 12–18 h	q 8–12 h	q 8–12 h	q 6–8 h	Loading dose of 15–20 mg/kg recommended by some clinicians Given by slow IV infusion, over at least 60 min Monitoring of serum trough level recommended (trough = 10–15 μg/mL) Doses adjusted in patients with renal failure For premature infants < 1000 g, 15 mg/kg q 24–36 h
*Sample should be obtained 30 min after a 30-min IV infusion.
^†The need to administer a test dose of amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph is controversial.
^‡ CefazolinSome Trade Names ANCEF KEFZOL Click for Drug Monograph does not cross the blood-brain barrier.

Recommended Dosages of Selected Parenteral Antibiotics for Neonates

			Interval of Administration
Antibiotic	Route of Administration	Individual Dose	Body Weight < 1200 g		Body Weight 1200 – 1999 g		Body Weight ≥ 2000 g
			Age		Age		Age
			≤ 7 days	8–28 days	0–7 days	≥ 8 days	0–7 days	≥ 8 days	Comments

AmikacinSome Trade Names AMIKIN Click for Drug Monograph *	IV, IM	7.5–10 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 8 h	q 12 h	q 8 h	Monitoring of serum drug levels required (peak = 20–30 μg/mL; trough = < 10 μg/mL) Dose reduction required for impaired renal function For term neonates, may be given as a single dose of 15–20 mg/kg/day
Amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph	IV	0.25–1 mg/kg	After dilution in 5% or 10% D/W (saline solution should not be used), infusion of a test dose of 0.1 mg/kg (maximum 1 mg) over 1 h to assess patient's febrile and hemodynamic response;^† if no serious adverse effects are observed, infusion of a therapeutic dose (usually 0.25–1.25 mg/kg over 2–4 h), which may be given the same day as the test dose After the patient improves, may give the dose every other day until therapy is complete Monitoring of K levels and hematologic and renal functions required
AmpicillinSome Trade Names OMNIPEN PRINCIPEN Click for Drug Monograph For meningitis	IV	50 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	IV as 15– to 30-min infusion (≤ 10 mg/kg/min)
For other diseases	IV, IM	25 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h
AztreonamSome Trade Names AZACTAM Click for Drug Monograph	IV, IM	30 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	Limited data For gram-negative bacilli only
CefazolinSome Trade Names ANCEF KEFZOL Click for Drug Monograph ^‡	IV, IM	20 mg/kg	q 12 h	q 12 h	q 12 h	q 12 h	q 12 h	q 8 h	Limited data No primary indication; not used as initial therapy for sepsis or meningitis
CefepimeSome Trade Names MAXIPIME Click for Drug Monograph	IV, IM	30 mg/kg	q 12 h	q 12 h until age 14 days	q 12 h	q 12 h until age 14 days	q 12 h	q 12 h until age 14 days	May be used for Pseudomonas aeruginosa infections Sometimes used for meningitis, although usually as a 2nd-line drug and not always recommended
CefepimeSome Trade Names MAXIPIME Click for Drug Monograph	IV, IM	50 mg/kg	—	q 8–12 h if age > 14 days	—	q 8–12 h if age > 14 days	—	q 8–12 h if age > 14 days
CefotaximeSome Trade Names CLAFORAN Click for Drug Monograph	IV, IM	50 mg/kg	q 12 h	q 8–12 h	q 12 h	q 8 h	q 8–12 h	q 6–8 h	Often a first-line therapy for neonatal meningitis
CeftazidimeSome Trade Names FORTAZ TAZICEF Click for Drug Monograph	IV, IM	50 mg/kg	q 12 h	q 8 h	q 12 h	q 8 h	q 8 h	q 8 h	Penetrates well into inflamed meninges 70–90% of drug excreted unchanged in urine
CeftriaxoneSome Trade Names ROCEPHIN Click for Drug Monograph	IV, IM	25–50 mg/kg	q 24–36 h	q 24–36 h	q 24 h	q 24 h	q 24 h	q 24 h	Limited data May cause biliary pseudolithiasis and, in jaundiced premature infants, may increase risk of bilirubin encephalopathy via displacement of bilirubin from albumin Contraindicated for 48 h after the infusion of Ca-containing solutions in infants ≤ 28 days For meningitis, 40–50 mg/kg q 12 h or 80–100 mg/kg q 24 h
ChloramphenicolSome Trade Names CHLOROMYCETIN Click for Drug Monograph	IV	25 mg/kg	q 24 h	q 24 h	q 24 h	q 24 h	q 24 h	q 12 h	Doses adjusted by monitoring serum drug levels and hematologic parameters For meningitis, desired peak serum levels = 15–25 μg/mL and trough levels = 5–15 μg/mL For other infections, dose adjusted to attain a peak level of 10–20 μg/mL and a trough level of 5–10 μg/mL Large variability in serum levels and serum half life, especially in preterm neonates
ClindamycinSome Trade Names CLEOCIN Click for Drug Monograph	IV, IM	5 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	For anaerobes and gram-positive cocci (not enterococci)
GentamicinSome Trade Names GARAMYCIN Click for Drug Monograph *	IV, IM	2.5 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 8–12 h	q 12 h	q 8 h	Monitoring of serum drug levels required (peak = 4–12 μg/mL; trough = 0.5–2 μg/mL) Dose reduction required for impaired renal function Reduction in frequency (to q 18–24 h) for very small, premature infants For term infants, possibly gentamicinSome Trade Names GARAMYCIN Click for Drug Monograph 4 mg/kg q 24 h (peak serum levels are 2–3 times higher)
Imipenem	IV	20–25 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 12 h	q 12 h	q 8 h	Limited data
KanamycinSome Trade Names KANTREX Click for Drug Monograph *	IV, IM	7.5–10 mg/kg	q 18–24 h	q 18–24 h	q 12–18 h	q 8–12 h	q 12 h	q 8 h	Monitoring of serum drug levels required (peak = 20–30 μg/mL; trough serum level should be < 10 μg/mL) Dose reduction required for impaired renal function Reduction in frequency (to q 18–24 h) required for very small, premature infants
MetronidazoleSome Trade Names FLAGYL Click for Drug Monograph	IV	7.5 mg/kg	q 24–48 h	q 24–48 h	q 24 h	q 12 h	q 12 h	15 mg q 12 h	Limited data Loading dose of 15 mg/kg, then a subsequent dose 48 h later in preterm infants and 24 h later in term infants and then q 12 h
NafcillinSome Trade Names UNIPEN Click for Drug Monograph For meningitis or endocarditis	IV	50 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	Monitoring of CBC and liver function required Primarily excreted via the biliary tract In jaundiced neonates, possible accumulation in serum, which may have adverse effects
For other diseases	IV, IM	25 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	—
For other diseases	IV, IM	37.5 mg/kg	—	—	—	—	—	q 6 h
OxacillinSome Trade Names BACTOCILL PROSTAPHLIN Click for Drug Monograph For meningitis or endocarditis	IV	50 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h
For other diseases	IV, IM	25 mg/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	—
For other diseases	IV, IM	37.5 mg/kg	—	—	—	—	—	q 6 h
Penicillin GSome Trade Names BICILLIN WYCILLIN Click for Drug Monograph , aqueous For meningitis	IV	50,000–75,000 units/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h	Maximum for group B streptococcal meningitis = 500,000 units/kg/day
For most other diseases	IV, IM	25,000 units/kg	q 12 h	q 12 h	q 12 h	q 8 h	q 8 h	q 6 h
Penicillin GSome Trade Names BICILLIN WYCILLIN Click for Drug Monograph , procaine	IM	50,000 units/kg	Not recommended	Not recommended	q 24 h	q 24 h	q 24 h	q 24 h	Caution: Sterile abscess and procaine toxicity
Piperacillin/TazobactamSome Trade Names ZOSYN	IV (dose based on piperacillinSome Trade Names PIPRACIL Click for Drug Monograph component)	50 mg/kg	q 12 h	—	q 12 h	—	—	—	May be increased to 100 mg/kg q 6 h in infants > 28 days
Piperacillin/TazobactamSome Trade Names ZOSYN		100 mg/kg	—	q 8 h	—	q 8 h	q 12 h	q 8 h
TobramycinSome Trade Names NEBCIN TOBI TOBREX Click for Drug Monograph *	IV, IM	2.5 mg/kg	q 18–24 h	q 18–24 h	q 12 h	q 8–12 h	q 12 h	q 8 h	Monitoring of serum drug levels (peak = 4–12 μg/mL; trough serum level should be < 2 μg/mL) Dose reduction required for impaired renal function Reduction in frequency (to q 18–24 h) required for very small, premature infants For term neonates, may be given as 4 mg/kg once/day (peak serum levels are 2–4 times higher with once/day dosing)
VancomycinSome Trade Names VANCOCIN Click for Drug Monograph	IV	10–15 mg/kg	q 24 h	q 24 h	q 12–18 h	q 8–12 h	q 8–12 h	q 6–8 h	Loading dose of 15–20 mg/kg recommended by some clinicians Given by slow IV infusion, over at least 60 min Monitoring of serum trough level recommended (trough = 10–15 μg/mL) Doses adjusted in patients with renal failure For premature infants < 1000 g, 15 mg/kg q 24–36 h
*Sample should be obtained 30 min after a 30-min IV infusion.
^†The need to administer a test dose of amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph is controversial.
^‡ CefazolinSome Trade Names ANCEF KEFZOL Click for Drug Monograph does not cross the blood-brain barrier.

Table 2

Print Open table in new window

Recommended Dosages of Selected Oral Antibiotics for Neonates*
Antibiotic	Dosage	Interval	Comments
AmoxicillinSome Trade Names AMOXIL TRIMOX Click for Drug Monograph	15 mg/kg	q 8 h	Limited data
AzithromycinSome Trade Names ZITHROMAX Click for Drug Monograph	5–10 mg/kg	q 24 h	Preferred drug for treatment or prevention of pertussis in neonates < 1 mo For treatment or prevention of pertussis, 10 mg/kg given once/day for 5 days For most other infections, 10 mg/kg given on day 1 and then 5 mg/kg given on days 2–5
ClindamycinSome Trade Names CLEOCIN Click for Drug Monograph ^†	5 mg/kg	q 6–8 h	Limited data
ErythromycinSome Trade Names ERY-TAB ERYTHROCIN Click for Drug Monograph ethylsuccinate	10 mg/kg	q 6–12 h	For chlamydial infections or pertussis in neonates > 1 mo Associated with idiopathic hypertrophic pyloric stenosis
FluconazoleSome Trade Names DIFLUCAN Click for Drug Monograph	3–6 mg/kg	q 24–72 h	For minor candidal infections, 6 mg/kg on day 1, then 3 mg/kg/dose q 24–72 h For serious infections, 12 mg/kg once/day recommend for all gestational and postnatal ages A first (loading) dose of 25 mg/kg also possibly considered During the 1st 2 wk of life, adjustment of dosing interval possibly necessary if renal function is abnormal
FlucytosineSome Trade Names ANCOBON Click for Drug Monograph	12.5–37.5 mg/kg	q 6 h	Limited data Used only with amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph to slow emergence of resistance Monitoring of levels recommended
NeomycinSome Trade Names NEO-FRADIN NEO-RX Click for Drug Monograph sulfate	33 mg/kg	q 8 h	For gastroenteritis caused by enteropathogenic strains of Escherichia coli May be systemically absorbed in neonates with severe diarrhea
RifampinSome Trade Names RIFADIN RIMACTANE Click for Drug Monograph	10 mg/kg	q 24 h	For TB
	5 mg/kg	q 12 h	For meningococcus prophylaxis, given for 2 days
	10 mg/kg	q 24 h	For Haemophilus influenzae prophylaxis, given for 4 days
*Unless otherwise stated, doses are for neonates who are > 7 days and > 2000 g.
^†The dose for neonates who are < 7 days old < 2000 g is 5 mg/kg q 12 h.

In neonates, the ECF constitutes up to 45% of total body weight, requiring relatively larger doses of certain antibiotics (eg, aminoglycosides) compared with adults. Lower serum albumin concentrations in premature infants may reduce antibiotic protein binding. Drugs that displace bilirubin from albumin (eg, sulfonamides, ceftriaxoneSome Trade Names
ROCEPHIN
Click for Drug Monograph
) increase the risk of kernicterus.

Absence or deficiency of certain enzymes in neonates may prolong the half-life of certain antibiotics (eg, chloramphenicolSome Trade Names
CHLOROMYCETIN
Click for Drug Monograph
) and increase the risk of toxicity. Changes in GFR and renal tubular secretion during the first month of life necessitate dosing changes for other drugs (eg, penicillins, aminoglycosides, vancomycinSome Trade Names
VANCOCIN
Click for Drug Monograph
).

Last full review/revision October 2009 by Mary T. Caserta, MD

Content last modified February 2012

Buy the Book

Previous: Cystic Fibrosis

Next: Congenital and Perinatal Cytomegalovirus Infection (CMV)

Audio

Figures

Photographs

Sidebars

Tables

Videos