C-Reactive Protein and Duration of Antibiotic Therapy in Neonatal Bacterial Infection

ABSTRACT

PURPOSE: To determine whether C-reactive protein (CRP) can be used as a parameter to assess the safety of discontinuing antibiotic therapy and allows a shorter course of therapy in neonates treated for suspected bacterial infection. METHODS: We have experienced 193 cases of suspected neonatal bacterial infection at Pusan Maryknoll Hospital. CRP levels were measured daily by immunonephelometry. Infants with initial CRP levels less than 0.8mg/dL were considered unlikely to be infected, and antibiotic therapy was stopped (group A; n=82). If three daily serial CRP levels were less than 0.8mg/dL, antibiotics were discontinued (group B; n=51). Sixty cases were treated for at least 7 days irrespective of CRP results (group C; n=60), and relapse rates of bacterial infection were compared between the three groups within one month after discharge. RESULTS: Within the one month follow-up period, two infants (2.4%) in group A, one infant (1.3%) in group B, two infants (3.3%) in group C received antibiotics for possible relapse of bacterial infection. The relapse rate in these groups was very low and frequency of a second course of antibiotic therapy between these groups was not different. CONCLUSION: These data allow considerably shorter courses of antibiotic therapy, safe discontinuation by three serial CRP measurement and show that CRP can be a key parameter for guiding the duration of antibiotic treatment. In addition, it would cut the length and cost of hospital stays and diminish the side effects of parenteral antibiotics.