Treatment Overview

Receiving a diagnosis of neonatal sepsis is a profoundly stressful experience for any parent. Instead of settling in at home, families often find themselves in the Neonatal Intensive Care Unit (NICU), watching their newborn fight a serious infection. This condition involves bacteria, viruses, or fungi entering a baby’s bloodstream, causing symptoms that range from temperature instability and lethargy to difficulty breathing. Rapid treatment is absolutely critical to clear the infection, prevent it from spreading to the brain or lungs, and support the baby’s developing organs. 

Because newborns have immune systems that are not yet fully developed, their ability to fight off germs is limited. Treatment plans are highly individualized, depending on whether the baby was born premature or full-term, the timing of the infection, and the specific organism causing the illness. 

Overview of treatment options for Neonatal Sepsis 

The immediate goal of treating neonatal sepsis is to eliminate the invading pathogen and stabilize the baby’s vital functions. Unlike chronic conditions that are managed over years, neonatal sepsis is an acute medical emergency requiring aggressive and fast-acting intervention. 

Medication is the primary defense. Doctors typically initiate treatment with broad-spectrum antibiotics immediately after cultures are taken, without waiting for the final results. This preemptive approach is standard because delays can be dangerous. Once the specific bacteria or virus is identified, the medication is adjusted to target that specific germ. In addition to drugs fighting the infection, supportive care is essential. This often includes intravenous (IV) fluids to maintain blood pressure, nutritional support, and respiratory assistance if the baby is struggling to breathe. 

Medications used for Neonatal Sepsis 

The core of sepsis treatment involves antimicrobial drugs designed to eradicate the infection from the bloodstream. 

Antibiotics: Antibiotics are the first-line treatment for bacterial sepsis. Clinical experience suggests that a combination of two antibiotics is typically used initially to cover a wide range of potential bacteria (World Health Organization, 2023). 

  • Ampicillin: A penicillin-type antibiotic often used to fight common bacteria like Group B Streptococcus. 
  • Gentamicin: An aminoglycoside that targets Gram-negative bacteria. 
  • Vancomycin or Cefotaxime: These may be used as second-line treatments if the bacteria are resistant to standard drugs or if meningitis is suspected. 

Antivirals: If a viral infection, like Herpes Simplex Virus (HSV), is suspected, doctors will prescribe antivirals. Acyclovir is the standard treatment for neonatal HSV, crucial for preventing central nervous system damage. 

Antifungals: Fungal infections, often treated with potent antifungals like Amphotericin B for severe cases such as Candida, can occur, especially in very low birth weight or long-term antibiotic infants. 

Vasoactive Agents: If septic shock causes dangerously low blood pressure, medications like Dopamine or Dobutamine are necessary. These drugs strengthen the heart’s pump and constrict vessels to maintain vital organ blood pressure. 

Parents can expect antibiotic treatment to last anywhere from 7 to 21 days, depending on the severity of the infection and how quickly the baby responds. 

How these medications work 

These medications function by targeting the specific biological mechanisms of the invading germs or supporting the baby’s own body functions. 

Antibiotics destroy the bacterial cell wall or block protein production, stopping growth and allowing the immune system to clear the infection. 

Antivirals (e.g., acyclovir) interfere with viral DNA replication, preventing the virus from spreading. 

Vasoactive agents stimulate cardiovascular receptors, increasing heart force and tightening blood vessels to ensure oxygenated blood reaches the brain and kidneys. 

Side effects and safety considerations 

While these life-saving medications are necessary, they do carry risks that NICU teams monitor closely. 

Antibiotics (like gentamicin) can be kidney and ear-toxic (ototoxicity) if blood levels are too high. Doses are adjusted via frequent blood draws to prevent hearing loss or kidney damage. Long-term use can also cause gut issues by disrupting healthy bacteria. Antivirals may affect liver function or lower white blood cell counts. IV therapy risks infiltration (fluid leakage causing swelling/irritation). 

If a baby shows signs of worsening lethargy, a new rash, or a sudden change in heart rate during treatment, the care team will intervene immediately. Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care. 

References 

  1. World Health Organization. https://www.who.int 
  1. National Institutes of Health. https://www.nih.gov 
  1. Centers for Disease Control and Prevention. https://www.cdc.gov 
  1. American Academy of Pediatrics. https://www.aap.org 

Medications for Neonatal Sepsis

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Neonatal Sepsis.

Found 1 Approved Drug for Neonatal Sepsis

Arikayce

Generic Name
Amikacin

Arikayce

Generic Name
Amikacin
Form: Injection, Suspension
Method of administration: Respiratory (inhalation), Intravenous, Intramuscular
FDA approval date: December 24, 2013
Classification: Aminoglycoside Antibacterial
Amikacin Sulfate Injection USP is indicated in the short-term treatment of serious infections due to susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, species of indole-positive and indole-negative Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter ( Mima-Herellea ) species. Clinical studies have shown Amikacin Sulfate Injection USP to be effective in bacterial septicemia (including neonatal sepsis); in serious infections of the respiratory tract, bones and joints, central nervous system (including meningitis) and skin and soft tissue; intra-abdominal infections (including peritonitis); and in burns and post-operative infections (including post-vascular surgery). Clinical studies have shown amikacin also to be effective in serious complicated and recurrent urinary tract infections due to these organisms. Aminoglycosides, including Amikacin Sulfate Injection USP are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are not susceptible to antibiotics having less potential toxicity.Bacteriologic studies should be performed to identify causative organisms and their susceptibilities to amikacin. Amikacin may be considered as initial therapy in suspected Gram-negative infections and therapy may be instituted before obtaining the results of susceptibility testing. Clinical trials demonstrated that amikacin was effective in infections caused by gentamicin and/or tobramycin-resistant strains of Gram-negative organisms, particularly Proteus rettgeri, Providencia stuartii, Serratia marcescens, and Pseudomonas aeruginosa. The decision to continue therapy with the drug should be based on results of the susceptibility tests, the severity of the infection, the response of the patient and the important additional considerations contained in the WARNINGS box above. Amikacin has also been shown to be effective in staphylococcal infections and may be considered as initial therapy under certain conditions in the treatment of known or suspected staphylococcal disease such as, severe infections where the causative organism may be either a Gram-negative bacterium or a staphylococcus, infections due to susceptible strains of staphylococci in patients allergic to other antibiotics, and in mixed staphylococci/Gram-negative infections. In certain severe infections such as neonatal sepsis, concomitant therapy with a penicillin-type drug may be indicated because of the possibility of infections due to Gram-positive organisms such as streptococci or pneumococci. To reduce the development of drug-resistant bacteria and maintain the effectiveness of amikacin and other antibacterial drugs, amikacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
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