Rational use of antibiotics in neonatal infections.

Review of the management of neonatal infections is done with the aim of guiding the clinician on appropriate therapy. Minimum investigations should include a white blood cell count including the L:T ratio and a blood culture. The bulk of infections at Kenyatta National Hospital newborn unit are caused by Klebsiela, Citrobacter and Staphylococcus aureus. During the 1990's considerable resistance to gentamicin has developed. Currently, cephalosporins chloramphenicol have the best sensitivity pattern. The diagnosis must be carefully verified at different stages of treatment to ensure that only those requiring antimicrobial therapy get it. Indiscriminate use is thus avoided. This in turn minimises development of antibiotic resistant organisms. Failure of response to antimicrobials sometimes means a non infectious cause of illness or poor supportive management. Continuous surveillance is recommended with emphasis on primary prevention of infection as well as cross infections.