Present status of antibiotic abuse and drug-resistant bacteria increase, Australia Isaacs has reported how the rational use of antibiotics the neonatal period.
Late neonatal sepsis: in 1987, in Oxford, with clinical suspected of penicillin g and gentamicin in the treatment of early neonatal sepsis (within 48 hours after birth), flucloxacillin and gentamicin in the treatment of clinical suspicion of advanced neonatal sepsis. Yihou, little early change of pathogenic bacteria in neonatal sepsis, group b streptococci and Escherichia coli is still the major pathogenic bacteria, its experience in the treatment with ampicillin or penicillin g and a combined application of aminoglycoside antibiotics. However, later a change in the pathogenic bacteria of neonatal sepsis. In Australia and the United States and the United Kingdom and many other countries, coagulase-negative staphylococci are the most common pathogen of late neonatal sepsis, accounting for more than 50%, and most of the resistance to Methicillin (Australia accounted for more than 90%).
Pathogenic bacteria of norvancomycin and vancomycin-resistant: with the increase in infection, many of Australia and the United Kingdom in neonatal Ward, use of Vancomycin as a suspicious one front-line experience of advanced neonatal sepsis drug use. Vancomycin is a glucoside class antibiotics effective against most Gram-positive bacteria, Gram-negative bacteria and anaerobes are invalid. There is currently no effective antibiotics in the treatment of Vancomycin resistance of Gram positive bacteria appear worried. First to appear are vancomycin-resistant Enterococcus, and later of vancomycin-resistant Staphylococcus aureus occurs.
Flucloxacillin: due to the risk of smaller, aminoglycoside antibiotic flucloxacillin and as first-line drugs unless blood culture for coagulase-negative staphylococci (or gram positive cocci) use of Vancomycin.
Aminoglycoside: aminoglycoside antibiotic is cheap and effective, there are 3 issues affecting their application: resistance 1; 2 differ from the 3rd generation cephalosporin, aminoglycoside antibiotics by no less inflammatory Meningioma; 3 detection of serum concentration of aminoglycoside antibiotics less expensive.
Third generation cephalosporins: due to the problems of aminoglycoside, many neonatal units use 3rd generation cephalosporins has been suspected of advanced neonatal sepsis. 3rd generation cephalosporins are broad-spectrum antibiotics, most gram-negative bacteria and many Gram-positive bacteria effectively. However, the long-used, can be caused by fungal infection. In 1983, Germany first reported the hyper-spectrum β-lactamase-producing gram-negative bacteria appear clearly associated with the abuse of 3rd generation cephalosporin. (ArchDisChildFetalNeonatalEd2000，82∶F1)
In short, for suspected late neonatal sepsis, as Ward No Methicillin-resistant Staphylococcus aureus and cerebrospinal fluid in children with normal, preferred flucloxacillin and aminoglycoside antibiotics (gentamicin). In an outbreak or when cerebrospinal fluid in children with abnormal, the choice of 3rd generation cephalosporin. Shortened course of antibiotics is very important. If no pneumonia in neonates from tracheal intubation in aspiration of bacteria cultured bacteria can be used for processing, not infections without antibiotics. On the existence of invasive instruments (such as umbilical artery and vein intubation, thoracic drainage tube, even endotracheal intubation) the use of prophylactic antibiotics in children, cannot prevent sepsis occurs, and is likely to cause the emergence of multidrug-resistant strains.
Isaacs considered, 1 rational use of antibiotics, strictly control the use of antibiotics; 2 as using narrow-spectrum antibiotics; 3 retains a strong broad-spectrum antibiotic application later if needed; 4 if blood culture negative, 2-3 days after the antibiotic is stopped as soon as possible; 5 treatment of sepsis bacteria without treatment; 6 if there is no valid evidence, do not use of prophylactic antibiotics.
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