Empirical antibiotic therapy is being started for a 20-day-old neonate with CSF-proven bacterial meningitis. Which combination is preferred, and why is the third-generation cephalosporin ceftriaxone avoided in this age group?

• A Ampicillin plus gentamicin; ceftriaxone lacks CSF penetration
• B Meropenem plus vancomycin; ceftriaxone causes renal failure in neonates
• C Ceftriaxone monotherapy; combination therapy increases resistance
• D Ampicillin plus cefotaxime; ceftriaxone displaces bilirubin and precipitates with calcium ✓

Explanation

Standard empirical therapy for neonatal meningitis is ampicillin plus cefotaxime, which covers Group D Streptococcus, Listeria and gram-negative bacilli. Ceftriaxone is avoided in neonates because it displaces bilirubin from albumin, raising free bilirubin and the risk of kernicterus, and because it forms insoluble calcium-ceftriaxone complexes. Ceftriaxone actually penetrates CSF well, so option A gives a wrong reason, and meropenem plus vancomycin is reserved for resistant or refractory cases.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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