Neonates with early onset sepsis or septic shock who are severely unwell and may 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 severely unwell and may have meningitis (ie not excluded by lumbar puncture), use:
cefotaxime 50 mg/kg intravenously cefotaxime
neonate younger than 37 weeks postmenstrual age1: 12-hourly
neonate 37 weeks postmenstrual age or older1: 8-hourly
PLUS
benzylpenicillin 90 mg/kg intravenously benzylpenicillin
neonate younger than 37 weeks postmenstrual age1: 12-hourly
neonate 37 weeks postmenstrual age or older1: 8-hourly.
In neonates suspected to have HSV infection, or whose birthing parent had active genital HSV infection at birth, add aciclovir to the above regimenAustralasian 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 active 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. Ceftriaxone is preferred over cefotaxime when administered intramuscularly due to its long half-life. Cefotaxime should be used rather than ceftriaxone in neonates receiving intravenous calcium solutions (including parenteral nutrition), or those with jaundice, hypoalbuminaemia, acidosis, unconjugated hyperbilirubinaemia or impaired bilirubin binding. For more information, see Practical information on using beta lactams: cephalosporins.
If intravenous (or intraosseous) access cannot be rapidly established in term and preterm neonates, as a 2-drug regimen, use:
1ceftriaxone 50 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access ceftriaxone
OR
2cefotaxime 50 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access cefotaxime
PLUS with either of the above regimens
benzylpenicillin 90 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access. benzylpenicillin
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. If switching from intramuscular ceftriaxone to intravenous cefotaxime, administer the first cefotaxime dose 12 hours after the intramuscular ceftriaxone dose.