Antimicrobial treatment of neonatal meningitis

Check your answers on page 42

Neonatal meningitis is characterised as an infection in the meninges, the protective membranes surrounding the brain and spinal cord, occurring within the first 28 days of life. Neonates are at their most susceptible to infection in this period due to the immature activation and function of their immune responses (Verklan et al, 2021).

When neonatal meningitis is suspected, early initiation of antimicrobial therapy is essential. Antibiotic therapy is guided by whether the infection is early onset (less than 7 days of age when the origin may be from in utero, maternal or at birth exposure) or late onset (after 7 days of life and origin of the causative pathogen may be environment, including hospital-acquired infection).

With early onset suspected meningitis, amoxicillin and cefotaxime are the antibiotics of choice until a specific organism is cultured and sensitivity known. Amoxicillin is a semi-synthetic penicillin, with bactericidal activity against both gram-positive and gram-negative organisms (Huttner et al, 2020). Cefotaxime, as a third-generation cephalosporin, has increased antimicrobial activity against gram-negative bacilli in addition to enhanced penetration across the blood–brain barrier when compared to gentamicin (National Institute for Health and Care Excellence (NICE), 2021) (Table 1).