Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit

Semin Perinatol. 2012 Dec;36(6):431-6. doi: 10.1053/j.semperi.2012.06.005.


The judicious use of antibiotics is an important means to limit the emergence of antibiotic-resistant organisms. Although specific guidelines for neonates are often lacking, antibiotic stewardship principles can be applied to the neonatal intensive care unit. Principles include accurately identifying patients who need antibiotic therapy, using local epidemiology to guide the selection of empiric therapy, avoiding agents with overlapping activity, adjusting antibiotics when culture results become available, monitoring for toxicity, and optimizing the dose, route, and duration of therapy. Neonatal intensive care units should develop interdisciplinary antimicrobial stewardship teams with the support of their institutions. Prescriber audit and feedback, as well as preauthorization and formulary restriction of selected antibiotics, are recommended antimicrobial stewardship interventions. Ancillary strategies include education and computerized decision support. Metrics to evaluate antimicrobial stewardship programs should include measurements of patient safety and quality, such as rates of adverse drug events, and appropriate dosing and timing of perioperative prophylaxis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Antibiotic Prophylaxis* / methods
  • Antibiotic Prophylaxis* / standards
  • Clinical Protocols / standards
  • Cross Infection / drug therapy*
  • Drug Monitoring / methods
  • Drug Resistance, Microbial
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal* / organization & administration
  • Intensive Care Units, Neonatal* / standards
  • Medication Therapy Management / standards*
  • Microbial Sensitivity Tests / methods
  • Patient Care Team / organization & administration
  • Patient Selection
  • Practice Guidelines as Topic
  • Prescription Drug Misuse


  • Anti-Bacterial Agents