Antibiotic Use in NICU Patients

High-Risk Antibiotics to Avoid or Use with Extreme Caution

Fluoroquinolones, such as Ciprofloxacin, are not FDA-approved for routine use in children under 18 years and may be associated with potential cartilage toxicity in developing joints, according to the American Academy of Pediatrics 1
Tetracyclines, including Tigecycline, are not recommended in patients under 18 years of age unless no alternative antimicrobial agents are available, and can cause permanent tooth discoloration and enamel hypoplasia in developing teeth, as suggested by the American Academy of Pediatrics 1
Nitrofurantoin is not approved for use in children under 12 years by the FDA and should not be used for pyelonephritis or perinephric abscess, as recommended by the American Academy of Pediatrics 1

For early-onset sepsis, the American Academy of Family Physicians recommends Ampicillin plus gentamicin (with appropriate monitoring) 2, 3
For late-onset sepsis, the European Society of Clinical Microbiology and Infectious Diseases recommends Ampicillin plus gentamicin or Vancomycin for suspected MRSA or coagulase-negative staphylococci 3

The American Academy of Pediatrics suggests using weight-based dosing specific to gestational and postnatal age when initiating antibiotics in neonates 1
The American Academy of Pediatrics recommends adjusting dosing based on renal function and gestational age when using antibiotics in neonates 1