Choosing Wisely:

Avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection.

Rationale and Comments: There is insufficient evidence to support antibiotic treatment for more than 48 hours to rule out bacterial infection in asymptomatic term and preterm infants. Current blood culturing systems identify the great majority of pathologic organisms prior to 48 hours. Prolonged antibiotic use may be associated with necrotizing enterocolitis and death in extremely low-birth-weight infants.
Sponsoring Organizations:
  • American Academy of Pediatrics - Section on Perinatal Pediatrics
  • Sources:
  • Expert consensus
  • Disciplines:
  • Infectious disease
  • Pediatric
  • Neonatology
  • References: • Cotten CM, Smith PB. Duration of empirical antibiotic therapy for infants suspected of early-onset sepsis. Curr Opin Pediatr. 2013 Apr;25(2):167-71.
    • Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, S├ínchez PJ, Ambalavanan N, Benjamin DK Jr; NICHD Neonatal Research Network. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics. 2009 Jan;123(1):58-66.
    • Garcia-Prats JA, Cooper TR, Schneider VF, Stager CE, Hansen TN. Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics. 2000 Mar;105(3 Pt 1):523-7.

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