In a neonate with suspected sepsis and persistent hypothermia, which antibiotic regimen is commonly used?

• A. Ampicillin and gentamicin
• B. Cefotaxime alone
• C. Penicillin G alone
• D. Ampicillin and cefotaxime

Answer: (A)

When a neonate is suspected of sepsis, the priority is rapid, broad coverage against the pathogens most likely to cause infection in newborns. Ampicillin plus gentamicin provides that coverage: ampicillin targets Listeria and Group B Streptococcus, while gentamicin covers many Gram-negative bacteria such as E. coli. This combination is a proven, reliable empiric therapy for neonatal sepsis and is started while cultures are pending to quickly control infection and reduce mortality risk. Penicillin G alone misses many Gram-negative pathogens, so it isn’t sufficient as sole therapy. Cefotaxime alone also falls short because it doesn’t cover Listeria and has been associated with less favorable outcomes in neonates when used as initial empiric therapy. A regimen of ampicillin with cefotaxime can be used in some situations, but it isn’t the standard first-line choice given safety and efficacy considerations in newborns.