Neonates with early onset sepsis or septic shock who are not severely unwell, or are severely unwell but do not have meningitis

For term and preterm neonates with early onset sepsis or septic shock (occurring within 72 hours of birth) of unknown source who are not severely unwell, or are severely unwell but do not have meningitis (ie excluded by lumbar puncture), as a 2-drug regimen, use:

In neonates suspected to have HSV infection, or whose birthing parent had active genital HSV infection at birth, add aciclovir to the above regimensAustralasian Society for Infections Diseases (ASID) 2022. Use:

For more information on the management of neonates suspected to have HSV infection, or whose birthing parent had genital HSV infection at birth, see the Australasian Society for Infectious Diseases (ASID) Management of Perinatal Infections guidelines.

If HSV infection is confirmed, see Neonatal herpes simplex infection for subsequent management.

If intravenous (or intraosseous) access cannot be rapidly established (eg within 15 minutes), the initial dose of antimicrobial therapy can be administered intramuscularly. For term and preterm neonates with early onset sepsis or septic shock who are not severely unwell, or are severely unwell but do not have meningitis (ie excluded by lumbar puncture), as a 2-drug regimen, use:

Aciclovir cannot be administered intramuscularly; if HSV infection is suspected, seek expert advice.

Establish intravenous (or intraosseous) access before the next scheduled antimicrobial dose. There are few data on absorption and distribution of intramuscular antimicrobials in sepsis or septic shock.