Duration of therapy

Initial clinical suspicion of infection was not strong (based upon baby’s presentation and maternal history)

Baby’s clinical condition is reassuring with no clinical indicators of possible infection

Levels and trends of CRP and WBC are not concerning.

Suspected infection with negative cultures: 7 days

UTI: 10-14 days

Uncomplicated bacteremia: 7-14 days from first negative blood culture

• Cultures are negative AND baby remains unwell after 5-7 days

• OR unusual pathogen/site of infection

• OR gram negative sepsis

• OR confirmed meningitis

L. monocytogenes: 21 days

GBS:
Treat with penicillin and gentamicin. Can switch to penicillin alone once GBS is identified and after sterilization of CSF has occurred upon repeat LP or when clinical and microbiological response have been documented. Minimum treatment course: 14-21 days.
If course is complicated a longer treatment duration may be warranted.

Gram negative bacilli:
Usually are treated with

cefotaxime initially in combination with gentamicin. Once sterility of the CSF is documented, gentamicin can be discontinued and the appropriate antibiotic (ie cefotaxime if susceptible) continued to complete a minimum of 21 days or at least 14 days of therapy after the CSF is sterile, whichever is longer. If course is complicated a longer treatment duration may be warranted.