C-reactive protein as a marker for guiding the duration of antibiotic therapy in suspected neonatal bacterial infection

ABSTRACT

The need to assign an effective and safe strategy to manage neonates with different forms of bacterial infections was an important objective among neonatologists at different centers. The classic approach is to provide the appropriate antibiotic regimen for cases with proved bacterial infection for a definite minimum duration and to discontinue the treatment after clinical and culture evidence of cure. This strategy, although reliable and effective, was found to pose a burden of longer duration of hospital stay and antibiotic therapy with undesired medical and economic consequences. This study was prospectively done to evaluate the use of C-reactive protein [CRP] as a reliable and safe guide to stop antibiotic therapy in those patients. It included 306 term neonates with suspected bacterial infection. C-reactive protein was highly sensitive in confirming bacterial infection in all the 72 cases [23.5%] who had positive cultures and was extremely specific in excluding bacterial infection in all the 234 [76.5%] neonates with negative cultures. Follow up of neonates with culture proved bacterial infection showed that, CRP value < 10 mg/dl could be used as a quite effective marker to terminate antibiotic therapy in neonates with various forms of bacterial infections, including the serious forms; septicemia and/or meningitis. The duration of antibiotic treatment in the group of neonates with CRP guided protocol was significantly less than the duration of treatment in the group guided by culture evidence of cure. At the same time, there was no significant difference in the rate of relapse among both groups. The results obtained in this study might provide a highly needed guide to limit the unnecessary use of antibiotics, in an economic, easy, safe and reliable manner, a situation that would be of great value in countries with rather limited economic resources