Modification and duration of therapy for Enterobacterales bloodstream infections in neonates and children younger than 3 months
In neonates and children younger than 3 months with a bloodstream infection caused by Enterobacterales, modify therapy based on antimicrobial susceptibilities; use the narrowest-spectrum suitable beta lactam (eg ampicillin, cefotaxime, ceftriaxone).
In neonates and children younger than 3 months with meningitis, discuss treatment duration with a clinical microbiologist or infectious diseases physician. In neonates, intravenous therapy should continue for at least 3 weeks and until the CSF cultures are negative – seek expert advice for all cases.
For neonates and children younger than 3 months without meningitis, 7 to 10 days of intravenous therapy is usually required. For children 1 month or older who are not immunocompromised and do not have a deep-seated or uncontrolled source of infection, a switch from intravenous to oral therapy may be appropriate if adequate antibiotic exposure at the site of infection is likely (eg bacteraemia with a urinary tract source). In neonates, intravenous therapy should be used for the entire course of treatment.