Antibiotic Strategies in Neonatal Intensive Care: A Narrative Review

Background: Antibiotics are among the most frequently prescribed therapies in neonatal intensive care units (NICUs), largely because neonates are highly susceptible  to infection and neonatal sepsis has nonspecific clinical manifestations. Although early empirical antibiotic therapy is essential and often lifesaving, increasing evidence suggests that inappropriate initiation, prolonged duration, and excessive use of broad-spectrum antibiotics may contribute to antimicrobial resistance, disruption of the neonatal microbiome, and unfavorable short- and long-term outcomes.  Objectives: This review aimed to synthesize current evidence on antibiotic utilization in NICUs and identify key challenges in optimizing their use. Methods: A comprehensive narrative review was conducted by searching electronic databases, including PubMed, Scopus, and Web of Science. Articles published in English addressing antibiotic utilization, indications for therapy, duration of treatment, and outcomes in neonates admitted to NICU were reviewed. Results: Findings from the reviewed literature indicate that a large proportion of neonates admitted to NICU receive antibiotic therapy, with the highest antibiotic exposure observed among preterm and low-birth-weight infants. Empirical antibiotics are frequently initiated for suspected early- and late-onset sepsis, often without microbiological confirmation, leading to unnecessary prolonged exposure. Such practices have been linked to increased risks of antimicrobial resistance, NEC, invasive fungal infections, and persistent alterations in gut microbiota. Conclusion: Antibiotic use in NICUs remains widespread and heterogeneous across institutions.  Enhancing antibiotic stewardship interventions, emphasizing evidence-based guidelines, and promoting timely de-escalation or discontinuation of therapy are crucial to improving neonatal outcomes and mitigating the growing threat of antimicrobial resistance.

کلیدواژه ها:

Neonates ، Antibiotic stewardship ، Antimicrobial resistance ، Pharmacokinetics