# Current antibiotic and prophylactic antifungal drug policies in UK neonatal intensive care units: a national survey

## TL;DR

This study surveyed UK neonatal intensive care units to understand their current antibiotic and antifungal drug policies for treating infections in newborns.

## Contribution

The study provides a comprehensive national overview of antibiotic and antifungal treatment guidelines in UK NICUs, highlighting variations and recent trends.

## Key findings

- Most NICUs use a penicillin and aminoglycoside combination as first-line treatment for early-onset sepsis.
- There is significant variation in antibiotic regimens for late-onset sepsis and meningitis across NICUs.
- Antifungal prophylaxis is more common now than in 2006–07 but remains inconsistent across units.

## Abstract

To survey the current antibiotic and antifungal drug practices of UK neonatal intensive care units (NICUs), and to identify antibiotic preferences and policies for treatment of early- and late-onset sepsis (EoS and LoS), meningitis, and antifungal prophylaxis.

Between January and May 2024, we contacted all 53 tertiary-level UK NICUs via telephone and/or e-mail. We requested a copy of each unit’s guidelines for antibiotic treatment of EoS and LoS, and antifungal prophylaxis.

We obtained guidelines from 53/53 (100%) units. A penicillin and aminoglycoside combination was the consistent first-line recommendation for EoS in 51/53 (96%) units. Only a minority (11/53; 21%) units specified any second-line antibiotic regimen for EoS, though most (44/53; 83%) specifically recommended amoxicillin for suspected listeriosis. For LoS, almost all NICUs (52/53; 98%) provided specific guidance on empirical first-line antibiotic treatment, with empirical narrow-spectrum antibiotics as first-line LoS treatment for term neonates in 42/53 (79%) NICUs and for preterm neonates in 41/53 (77%) NICUs. Fifty-four percent (29/53) of units included specific LoS recommendations for neonates with indwelling central venous catheters. Sixty-six percent (35/53) of NICUs included cefotaxime in their empirical meningitis regimens. Eighty-five percent (45/53) of units had clear guidelines for antifungal prophylaxis.

While EoS treatment was consistent across units, there remained wide variation in antibiotic regimens used for LoS and meningitis, and for neonates with indwelling central venous catheters. Guidelines specific to preterm neonates were limited. The practice of routine antifungal prophylaxis has been more prevalent since the last UK survey in 2006–07 but is still neither universal nor consistent.