A 2-day-old term neonate presents with clinical signs of early-onset sepsis and confirmed meningitis. The pediatrician decides to avoid gentamicin despite its common use in empirical sepsis regimens. What is the primary reason for avoiding gentamicin in neonatal meningitis?

• A High risk of ototoxicity
• B Lack of activity against Group B Streptococcus
• C Poor penetration into the cerebrospinal fluid ✓
• D Risk of gray baby syndrome

Explanation

Gentamicin has very poor penetration into the cerebrospinal fluid, making it unreliable for treating neonatal meningitis. Cefotaxime is preferred for gram-negative coverage in meningitis because it achieves excellent CSF concentrations. While ototoxicity is a known adverse effect of aminoglycosides, the primary reason for avoiding gentamicin in meningitis is its inability to reach therapeutic levels in the CSF.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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