Strategies for the treatment of bacterial infections in the newborn.

Antibiotics are widely used in the treatment of premature low birth-weight babies, either as blind therapy before infection is confirmed or, more specifically against a pathogen of known antibiotic susceptibility. The requirements of an antibiotic for use in the newborn are different from those in older patients and in almost every respect there are differences in the pharmacology and pharmacokinetics of antibiotics in the very young. A wide range of bacteria are responsible for infection in the new born and the distribution of these organisms will vary not only from country to country, but also from hospital to hospital. Antibiotics in current use are less effective against bacteria infecting the newborn than they once were and the introduction of new antibiotics, notably the third generation cephalosporins, provides an opportunity to reassess current antibiotic practices. This paper outlines the general considerations for chemotherapy in small babies and attempts to identify those areas where a review of current antibiotic practice is required. It is essential that decisions regarding antibiotic policies for neonatal units should be made locally and that they reflect local experience and the range of pathogens most frequently encountered and their sensitivity patterns.