Table 1.

Summary of recommendations for agent and duration of antimicrobial therapy for commonly encountered conditions in the NICU.

Condition	Suggested antibiotics and duration	Comments
Early-onset sepsis
Empirical antimicrobial use with negative blood and/or culture	Ampicillin and Gentamicin as empirical choice. To be discontinued in 36–48 h in general	Early cessation of antibiotics to be supported by the clinical and laboratory findings.
Culture-proven bacteremia	7–10 days
Culture-proven meningitis	14–21 days	14–21 day for meningitis caused by Gram positive organisms; at least 21-day recommended for E. Coli and other meningitis caused by Gram-negative bacilli
Late-onset sepsis
Empirical antimicrobial use with negative blood and/or culture	Cloxacillin & Gentamicin or per local antibiogram/ patient characteristics. To be discontinued in 36–48 h	Early cessation of antibiotics to be supported by the clinical and laboratory findings.
Culture-proven bacteremia	7–14 days	14-day for S. aureus bacteremia; timely removal of catheter being the key to reduce treatment failure
Culture-proven meningitis	14–21 days	14–21 day for meningitis caused by Gram positive organisms; at least 21-day recommended for E. Coli and other meningitis caused by Gram-negative bacilli
Ventilator-associated pneumonia (VAP)
VAP	7–8 days	Longer treatment duration for those with complicated VAP or secondary bacteremia.
Necrotizing enterocolitis (NEC)
NEC	Ampicillin and gentamicin ± metronidazole or clindamycin; Piperacillin-tazobactam as a single agent Stage I: 3 days Stage II: 5–7 days Stage III 10–14 days	In case of intra-abdominal abscesses, antibiotics should be continued until clinical and radiological responses are established.
Urinary tract infection (UTI)
UTI	5–7 days of parenteral therapy	Oral therapy is not recommended for premature neonates.