DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20173796

A study on validity of C-reactive protein in deciding the duration of antibiotic therapy in suspected neonatal bacterial infection

Prashanth Siddaiah, Pradeep Nanjappa Shetty, Krishna N. W., Sowmya Jagadeeshwara

Abstract


Background: Neonatal septicemia is defined as generalized bacterial infection of newborns documented by positive blood culture in first four weeks of life. Objective of present study was to determine whether C-Reactive protein can be used as a parameter to identify the time point when antibiotic treatment can safely be discontinued in a defined major subgroup of neonates treated for suspected bacterial infection.

Methods: A total of 50 neonates with birth weight more than 1500gms with suspected septicemia were enrolled in the prospective study. Serum CRP were determined 24-48 hours after the first dose of antibiotics. If CRP was less than 6mg/l, infants were considered unlikely to be infected and the antibiotic treatment was stopped. If CRP was more than 6mg/l, antibiotics were continued and CRP measured on alternative days in one subgroup (2a) and on seventh day in another subgroup (2b). CRP was the single decision criterion to stop the antibiotic therapy. Negative predictive value with respect to further treatment was determined.

Results: Duration of antibiotic therapy could be reduced to less than seven days in 54% cases and < 72 hours in 48% cases.

Conclusions: Negative predictive value of serial CRP is 100% in deciding the duration of antibiotic therapy in suspected neonatal septicemia.


Keywords


C-reactive protein, Neonate, Septicemia

Full Text:

PDF

References


Pal V, Singh KM. Neonatal Sepsis. In Medical Emergencies in Children, 2nd Edn. Ed Singh Meharban Sagar Publication, New Delhi;1993:115.

Feigin RD, Cherry JD. eds Text book of Pediatric infectious diseases, 3rd Ed Philadelphia, PA: WB Saunders Co; 1994.

Avery GB. Diseases of the Newborn Infant. Philadelphia, PA: WB Saunders Co; 1991.

Remington J, Klein J. Infectious diseases of Fetus and Newborn infant. 4th Ed. Philadelphia P: WB Saunders Co;1995.

Vigushin D, Pepy M, Hawkins P. Metabolic and Seintigraphic studies of radionucleated human C-reactive protein in health and disease. Selin Investigation. 1993;91:1351-7.

Speer C, Bruns A, Gahr M. Sequential determination of CRP, alpha 1-antitrypsin and haptoglobin in neonatal septicaemia. Acta Paediatr Scand. 1983;72(5):679-83.

Sann L, Bienvenu F, Bienvenu J, Bourgeois J, Bethenod M. Evolution of Serum pre-albumin, C-reactive protein and orosomuoid in neonates with bacterial infection. J Pediatr. 1984;105:977-81.

Hindocha P, Campbell CA, Gould JD, Wojciechowski A, Wood CB. Serial study of C-reactive protein in neonatal septicemia. Arch Dis Child. 1984;59:435-8.

Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in South India. Indian Pediatr. 1998;35:851-8.

Namdeo UK, Singh HP, Rajput VJ, Shrivastva KK, Namdeo S. Bacteriological profile of neonatal septicemia. Indian Pediatr. 1987;24:53-56.

Mishra JN, Rai MG, Chakraborty S, Prasad S. Study of neonatal septicemia. Indian Pediatr. 1985;22:281-5.

Somu N, Shetty M, Kumar V, George L, Subramanium L, Balgopal RV. A clinical analysis of Septicemia in infancy. Indian Pediatr. 1976;13:443-6.

Sinha N, Deb A, Mukherjee AK. Septicemia in neonates and early infancy. Indian J Pediatr. 1986;53:249-256.

Guha DK, Jaspal D, Das K, Guha AR, Khatri RL, Kumar RS. Outcome of neonatal septicemia: a clinical and bacteriological profile. Indian Pediatr. 1978;15(5):423-7.

Bhakoo ON, Agarwal KC, Narang A, Bhattacharjee S. Prognosis and treatment of neonatal septicemia-a clinico-bacteriological study of 100 cases. Indian Pediatr. 1974;11(8):519-28.

Bhartiya D, Kapadia C, Sanghvi K, Singh H, Kelkar R, Merchant R. Preliminary studies on IL – 6 levels in healthy and septic Indian neonates. Indian Pediatr. 2000;37(12):1361-7.

Singh M, Narang A, Bhakoo ON. Evaluation of a sepsis screen in the diagnosis of neonatal sepsis. Indian Pediatr. 1987;24:39-43.

Sharma A, Kutty CV, Sabharwal U, Rathee S, Mohan H. Evaluation of sepsis screen for diagnosis of neonatal septicemia. Indian J Pediatr. 1993;60:559-63.

Jaswal RS, Kaushal RK, Goel A, Pathania K. Role of CRP in deciding duration of antibiotic therapy in Neonatal septicemia. Indian Pediatr. 2003;40:880-3.

Philip AGS. Response of C-reactive protein in neonatal group B, streptocoal infection. Pediatr Infect Dis J. 1985;4:145-150.

Ehl S, Gering B, Bartman P, Hogel J, Pohlandt F. CRP is a useful marker of guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics 1997;99:216-21.