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:

aciclovir 20 mg/kg intravenously, 8-hourly2. aciclovir

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.

1 postmenstrual age = gestational age + postnatal ageReturn
2 In neonates younger than 30 weeks corrected gestational age (corrected gestational age = postnatal age [time since birth] – weeks of prematurity), consider 12-hourly dosing if HSV infection has not been confirmed.Return