The effectiveness of empiric antibiotic therapy in the prevention of Early onset Sepsis

Introduction: Neonatal sepsis currently causes 1.6 million deaths annually in developing countries and it is also the main reason for hospitalization in Neonatal Intensive Care Unit. Early onset sepsis still remains the significant risk factor for mortality and morbidity in neonatal period. Objectives: To describe the outcome of neonates treated with empiric antibiotic for suspected early onset sepsis (EOS). Methods: Records of neonatal patients at three Malaysian general hospitals admitted within 72 hours of life and prescribed with empirical antibiotic therapy for suspected EOS were retrospectively reviewed. Results: A total of 894 cases meet the inclusion criteria and divided into premature (<36 weeks) and term (≥37 weeks) neonates group. More than 80% of neonates had respiratory symptoms during admission. However, there were significant differences in diagnosis among premature and term neonates (p=0.001). 60% of suspected EOS cases were premature neonates (n=531) and they were mainly diagnosed for respiratory distress syndrome, congenital pneumonia and presumed sepsis. Majority were born to mothers exposed to antibiotic and steroid during pregnancy. Many of these mothers also had prolong rupture of membrane > 18 h (p>0.05). Premature neonates required longer hospital stay, higher ventilator support and higher surfactant administration (p<0.05). Term neonates (n=363) were mainly diagnosed with congenital pneumonia, presumed sepsis, meconium aspirate syndrome and hypoxic ischemic encephalopathy. These observation were consistent with the high incidence of meconium stained amniotic fluid, perinatal asphyxia and fit symptoms (p<0.05). Penicillin plus gentamicin regimen was the standard therapy started within 24 h of life and the mean treatment duration being less than 4 days. The observed successful rates for the three hospitals were between 89 - 95%. Conclusions: Majority of the neonates presented with respiratory symptoms and standard empiric antibiotic regimen prescribed showed good coverage for prevention of EOS.