Table 3.

CDC Principles for Judicious Antibiotic Use: Relevant NICU Examples

‘Get Smart’ Principles	Examples for the NICU
Timely antibiotic management Accurately identify patients who need antibiotic therapy Obtain appropriate cultures prior to start of antibiotics Administer antibiotics promptly	Use biomarkers such as CRP to guide initiation of therapy. Obtain simultaneous CVC and peripheral blood cultures when possible. Obtain sufficient blood culture volumes, i.e., > 0.5 mL.
Appropriate selection, administration, and de-escalation of therapy Make empiric choices based on local antibiograms Do not give therapy with overlapping activity Give the Right Dose and Interval Stop therapy promptly if indicated by culture results Review and adjust antibiotics at all transitions of care Monitor for toxicity and adjust therapy accordingly	Change vancomycin to oxacillin once infection with MSSA determined. Aim for higher vancomycin troughs (15–20 mcg/mL) for suspected meningitis. Discontinue post-operative prophylaxis after 48 hours. Avoid redundant anaerobic spectrum coverage (e.g., metronidazole and piperacillin/tazobactram).
Access to expertise at point of care Develop and make available expertise in antibiotic use Ensure expertise is available to all physicians at the point of car	Develop an antimicrobial stewardship team incorporating neonatology, clinical pharmacy, hospital epidemiology infectious diseases, and nursing services. Obtain infectious diseases consultations.
Improved data monitoring and transparency Monitor and feedback data regarding antibiotic utilization and adverse events Make data visible to interdisciplinary care team.	Provide NICU-specific antibiograms for common pathogens. Measure and feedback data on antibiotic prescribing to neonatologists.