Random practice patterns of surgical antimicrobial prophylaxis in neonates

Abstract

Antimicrobial prophylaxis accounts for 75% of antibiotic use on pediatric surgical services, but controlled, prospective studies evaluating surgical prophylaxis in neonates are lacking. We surveyed pediatric surgeons at 21 centers to: (1) determine practice patterns in neonatal surgical prophylaxis and treatment of necrotizing enterocolitis (NEC), and (2) assess whether a prospective study evaluating the efficacy of a single agent in place of a multiple drug regimen would be indicated, practical, and have the potential to effect a positive change in practice patterns. Surgeons responded concerning prophylactic regimens for common congenital anomalies and treatment of NEC. The most common regimen was an ampicillin/gentamicin combination (55% to 82%), while 23% added clindamycin for contaminated alimentary tract cases and 41% added clindamycin for NEC. There was wide variation in dosage and duration of coverage. A prospective study would determine whether antimicrobial monotherapy provides equal or better clinical results than an ampicillin/gentamicin regimen; whether there are cost savings associated with monotherapy; and whether a shorter treatment scheme would be effective, safe, and feasible.