Antibiotic treatment for neonatal sepsis: changing trends and future directions

Abstract

Background: Neonatal sepsis is a serious and life-threatening condition with high morbidity and mortality, especially in preterm neonates in a Neonatal Intensive Care Unit (NICU). This article provides an updated review on the aetiology and diagnosis of neonatal sepsis, antibiotic management and antibiotic stewardship.

Methods: A literature search was conducted in PubMed, Embase, Cochrane Library and Scopus in January 2025, using the following MeSH terms: “sepsis”, “neonate” and “antibiotic”. Meta-analyses, randomized controlled trials, clinical trials and reviews published in the English language from 2005 to 2025 with patients in the neonatal age group were included. A total of 715 articles were identified and screened, and 85 studies were included in the final review.

Results: Neonatal sepsis remains a leading cause of mortality, with distinct pathogens identified in earlyonset and late-onset sepsis, ventilator-associated pneumonia, urinary tract infection and fungal infections. Early recognition, accurate diagnosis and timely commencement of empirical antibiotics are paramount for improved outcomes. Fungal prophylaxis is considered for at-risk neonates in some NICUs with a high incidence of fungal infection. Universal group B Streptococcus screening decreased the incidence of early onset sepsis, but the emergence of resistant strains of certain organisms present new challenges. Evidence-based antibiotic prescription guidelines, antibiotic stewardship programmes and quality improvement projects are essential for the prevention of antimicrobial resistance in the NICU.

Conclusion: Effective management of neonatal sepsis relies on early pathogen identification, judicious use of antibiotics and good antimicrobial stewardship. Future research directions include development of evidence- based protocols and improvement of rapid diagnostic techniques, combined with close monitoring and individualized care.

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