A 20-day-old term infant presents with fever, poor feeding, and lethargy. The anterior fontanelle is full. Lumbar puncture shows 300 WBC/uL with neutrophil predominance, protein 250 mg/dL, and glucose 15 mg/dL. Which empirical antibiotic combination is most appropriate?

• A Ceftriaxone plus vancomycin
• B Ampicillin plus cefotaxime ✓
• C Penicillin G plus gentamicin
• D Meropenem monotherapy

Explanation

In the first month of life the leading meningeal pathogens are group B Streptococcus and Escherichia coli, with Listeria monocytogenes also possible. Ampicillin covers group B Streptococcus and Listeria, while a third-generation cephalosporin such as cefotaxime covers E. coli and other gram-negative bacilli. Ceftriaxone is avoided in neonates because it displaces bilirubin and can precipitate kernicterus, and it is contraindicated with concurrent calcium-containing fluids. Meropenem is reserved for resistant gram-negative organisms.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.