| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Benzylpenicillin (early-onset)[1] | Beta-lactam antibiotic | Not applicable — neonatal guideline | Term: 50 mg/kg IV every 12 h × first week; preterm or per gestational age and corrected protocol | First-line for early-onset GBS sepsis in many UK pathways; combine with gentamicin; alternative ampicillin in WHO and US protocols |
| Gentamicin (early-onset)[1] | Aminoglycoside | Not applicable — neonatal guideline | Term: 5 mg/kg IV every 36 h initially; preterm extended interval per gestational age; trough level before 3rd dose | Combines with penicillin/ampicillin for synergy; renal monitoring if course extends; avoid prolonged exposure where possible |
| Ampicillin + cefotaxime (alternative for early-onset)[1] | Aminopenicillin + third-generation cephalosporin | Not applicable | Ampicillin 50 mg/kg IV every 12 h; cefotaxime 50 mg/kg IV every 12 h | Alternative regimen where local resistance favours; consider in suspected gram-negative sepsis or meningitis |
| Flucloxacillin + gentamicin (late-onset)[1] | Beta-lactamase-stable penicillin + aminoglycoside | Not applicable | Flucloxacillin 25–50 mg/kg IV every 8 h; gentamicin per protocol | Late-onset cover for staphylococcal and gram-negative infection; expand to vancomycin and meropenem in NICU outbreak or critical illness |
| Vancomycin (suspected MRSA / coagulase-negative Staph)[1] | Glycopeptide | Not applicable | 10–15 mg/kg IV every 8–12 h (per gestational age); TDM target trough 10–15 | Late-onset NICU sepsis with central line; trough monitoring; renal function review |
| Acyclovir (suspected HSV)[1] | Antiviral | Not applicable | 20 mg/kg IV every 8 h × 14–21 days per disease type | Add empirically to antibiotic in any neonate with seizure, hepatitis, sepsis-like presentation, or vesicular rash; HSV PCR on blood, CSF, surface swabs |
Risk-based assessment, empirical antibiotic choice, and management of early-onset and late-onset neonatal sepsis and meningitis.