Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey

Brendan McMullan, Celia Cooper, Naomi Spotswood, Rodney James, Cheryl Jones, Pamela Konecny, Christopher Blyth, Thursky Karen

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate quality and variation in antibiotic prescribing for neonatal sepsis.

Design: We analysed prescribing in hospitalised neonates using the National Antimicrobial Prescribing Survey in Australian neonates from 1 January 2014 to 31 December 2018.

Setting: Data from antibiotic point prevalence surveys performed in hospitals, ranging from rural hospitals to tertiary paediatric and maternity hospitals within Australia.

Patients: Admitted neonates <28 days of age from participating hospitals.

Main outcome measures: Variation and appropriateness in prescribing for neonatal sepsis and variation in dosing for gentamicin and benzylpenicillin across hospitals.

Results: A total of 415 prescriptions among 214 neonates from 39 different hospitals were included. The majority of prescriptions (342, 82.4%) were for neonates <7 days of age. The most commonly prescribed antibiotics were gentamicin and benzylpenicillin, with 323 (77.8%) prescriptions. Dosing variability was substantial, with doses ranging from 2 to 8 mg/kg for gentamicin (median 5 mg/kg, IQR 4-5) and from 45 to 72 mg/kg for benzylpenicillin (median 60 mg/kg, IQR 50-60), although only 13 (3.2%) and 19 (4.6%) prescriptions were locally assessed as inappropriate or non-compliant with guidelines, respectively. At time of audit, 22% of antibiotics had been given for more than 48 hours and 9% more than 72 hours, although microbiologically confirmed infection was documented in only nine (4.2%) neonates.

Conclusions: Prescribing for neonatal sepsis was dominated by use of benzylpenicillin and gentamicin with substantial variation in dosing. A small minority had culture-confirmed infection. Efforts to standardise antibiotic dosing and duration for suspected neonatal sepsis are recommended.

Original languageEnglish
Article numbere000643
JournalBMJ Paediatrics Open
Volume4
Issue number1
DOIs
Publication statusPublished - 2020

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    McMullan, B., Cooper, C., Spotswood, N., James, R., Jones, C., Konecny, P., Blyth, C., & Karen, T. (2020). Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey. BMJ Paediatrics Open, 4(1), [e000643]. https://doi.org/10.1136/bmjpo-2020-000643