Antibiotics and Pharmacotherapeutics in the Neonate

Neonates are unique related to the pharmacotherapeutics of medications. Pharmacokinetics and pharmacodynamics are affected by gestation, chronological age, and disease state. All care takers need to understand indications, therapeutic effect, and toxicity of commonly used therapies. Many neonates admitted to neonatal nurseries require antibiotic treatment for presumed sepsis, based on maternal history. Infants presenting with clinical symptoms, either early onset or later, require a sepsis evaluation with blood cultures, complete blood count, and depending on the timing of clinical symptoms, a lumbar puncture and urine culture. The choice of antibiotics for initial sepsis evaluation is based on the most common organisms seen at birth. Late-onset sepsis is treated based on the presenting clinical signs of the infant, presence of indwelling catheters, and hemodynamic stability. The importance of monitoring drug levels, renal and hepatic function, and organism susceptibility and sensitivity will guide the caregivers in dosing and timing of medications.