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JAC Advance Access published online on January 31, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm543
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland

Andrew Michael Russell Fernando1, Paul Trafford Heath1 and Esse Natasha Menson1,2,*

1 Division of Child Health, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK 2 Evelina Children’s Hospital at St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK

Received 17 October 2007; returned 27 November 2007; revised 15 November 2007; accepted 17 December 2007

* Corresponding author. Tel: +44-20-7188-4679; Fax: +44-20-7188-4612; E-mail: esse.menson{at}gstt.nhs.uk

Objectives: To review antibiotic and antifungal policies in British and Irish neonatal units (NNUs).

Methods: A telephone survey was performed regarding empirical antimicrobial guidelines of NNUs in the UK and Republic of Ireland.

Results: The response rate was 91% (202 of 222 NNUs). The guidelines from all responding units covered group B Streptococcus and Escherichia coli, the most common causes of neonatal septicaemia and meningitis. However, 19% did not cover Listeria, the cause of meningitis in 5% to 7% of cases in England and Wales. Second-line recommendations varied greatly between units, with widespread use of broad-spectrum agents. Fungal prophylaxis and treatment guidelines were generally rudimentary.

Conclusions: Empirical antimicrobial recommendations on many NNUs include broad-spectrum antibiotics without ensuring universal coverage of important pathogens. We raise concerns about the selection pressures exerted for resistant pathogens and invasive fungal disease, especially as few units specify fungal prophylaxis or treatment guidance. Development of rational guidelines for the UK and Irish neonatal units might help to optimize treatment while minimizing overuse of broad-spectrum agents.

Key Words: neonatal infection , antimicrobial agents , guidelines


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Comment on: Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland
J. Antimicrob. Chemother., August 1, 2008; 62(2): 429 - 430.
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