C-Reactive Protein as a Single Useful Parameter for
Discontinuation of Antibiotic Treatment in Thai
Neonates with Clinical Sepsis
Nawaporn Numbenjapon MD*,
Sangkae Chamnanwanakij MD*, Preeyapan Sangaroon MD*,
Sriluck Simasathien MD*, Veerachai Watanaveeradej MD*
Affiliation :
* Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
Background : Clinical sepsis is a common diagnosis in neonate and is usually treated with antibiotic. The duration of
treatment is usually more than five days or until all cultures from the patient’s samples reveal negative.
Objective : To determine whether quantitative C-reactive protein (CRP) level less than 10 mg/L could be used as a reliable
index for discontinuation of antibiotic treatment in Thai neonates with clinical sepsis.
Material and Method: All neonates with birth weight greater than 1,500 grams, diagnosed as clinical sepsis, were enrolled
to the study. Serum CRP was measured at 24 to 48 hours after the first dose of antibiotics. If CRP level was less than 10 mg/L,
infants were randomly divided to groups Ia and Ib. If CRP level was 10 mg/L or more, infants were randomly divided to
groups IIa and IIb. Antibiotics were discontinued promptly after the CRP level was reported in group Ia, while CRP level
was measured daily and antibiotics were discontinued after it returned to less than 10 mg/L in group IIa. In controlled
groups (Ib and IIb), antibiotics were continued until all bacterial cultures were negative. The outcome measurements were
the number of patients who required retreatment for clinical sepsis within three days and 28 days after discontinuing antibiotics.
Results : Of 98 neonates with clinical sepsis, 76 (77.6%) were in group I. The duration of antibiotic treatment in group Ia
was shorter than group Ib significantly, 1.68 vs. 5.47 days (p<0.01). One neonate in group Ia was retreated on the third day
after discontinuing antibiotics due to positive blood and urine cultures. The negative predictive value of CRP for
discontinuation of antibiotics in group I was 97.4%. The durations of antibiotic treatments were 5.27 and 7.09 days in group
IIa and IIb, respectively. One neonate in group IIa was retreated on the second day after discontinuing antibiotics since the
patient’s clinical and laboratory results suggested severe sepsis although all bacterial cultures were negative. No patient
was readmitted for treatment of sepsis within 28 days after discontinuing antibiotics.
Conclusion : CRP levels were less than 10 mg/L in the majority of neonates with clinical sepsis. The negative predictive
value for using this level as a guide for antibiotic discontinuation was 97.4%.
Keywords : Antibiotics, C-reactive protein, Neonatal sepsis
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