Use of serial C-reactive protein measurements for determination of the length of empiric antibiotic therapy in suspected neonatal sepsis

The management of neonatal sepsis especially in
developing countries is problematic. There is no single reliable
marker of infection available at the present. C-reactive protein
(CRP) has long been used as a marker of infection. Serial measurements
of CRP are recommended as a guide for duration of
antibiotic therapy.
Objective: To evaluate the serial CRP measurement as a guideline
for diagnosis and monitoring therapy and determining the
length of antibiotic treatment in suspected neonatal sepsis.
Methods: The present descriptive study involves newborns suspected
of having bacterial sepsis. CRP levels were measured
initially and at least twice at 24-hr intervals until blood culture
results were available. Antibiotic therapy started in neonates
with clinical signs and symptoms of suspected sepsis. In neonates
with negative blood culture, normal CRP (<6mg/L) was
used as a criterion for the length of antibiotic treatment provided
that the infants were in good clinical condition. These neonates
were followed up for one month after discharge.
Results: Antibiotic therapy was discontinued in 91 patients
who had negative blood cultures and two consecutive normal
CRP levels. These neonates were followed for one month after
discharge. Only one patient was re-admitted with pneumonia 21
days after discharge, giving negative predictive value of 98.9%
(CI95% 96.8%-100%). The mean±SD duration of treatment was
3.3±1.0 days in the study group and 5.9±1.7 days in neonates
prior to conducting the study (p<0.000).
Conclusion: Serial CRP measurement is a good practical guide
for discontinuing antibiotic therapy in neonates with suspected
sepsis. These neonates can be discharged from the hospital earlier,
with significantly reduced cost, complications of treatment
and family anxiety