Parenteral antibiotics for the treatment of serious neonatal bacterial infections in developing country settings

Background: A number of special issues must be considered when selecting simple, safe, inexpensive, and effective antimicrobial regimens for treatment of neonatal sepsis in developing country community settings. Methods: We reviewed available data regarding pharmacologic profiles of parenteral antibiotics with specific attention to properties relevant to their use in the treatment of neonatal infections in developing country communities. Results: For community-based management of neonatal infections, particularly attractive properties include efficacy and safety of extended-interval, intramuscular dosing regimens. The penicillins and cephalosporins have relatively favorable efficacy and safety profiles. Although the aminoglycosides have narrow therapeutic indices, when used appropriately, they are safe and effective. Although inexpensive and effective, the potential for significant life-threatening toxicity among neonates associated with chloramphenicol makes it the least preferred of the parenteral agents for empiric therapy. Conclusions: The preferred parenteral regimens for community and first-level facility use are a combination of procaine penicillin G and gentamicin, or ceftriaxone given alone, which are safe and retain efficacy when dosed at extended intervals (≥24 hours) by intramuscular administration.