A term neonate develops early-onset neonatal seizures within 12 hours of birth. The mother received adequate prenatal care and had prolonged rupture of membranes. CSF: glucose 20 mg/dL (blood glucose 80 mg/dL), protein 180 mg/dL, neutrophils 500/mm³. After blood cultures, the most appropriate empirical antibiotic regimen is:

• A Cefotaxime alone
• B Ampicillin + Gentamicin
• C Ampicillin + Cefotaxime ✓
• D Vancomycin + Cefotaxime

Explanation

For neonatal meningitis (as suggested by CSF pleocytosis, elevated protein, low glucose), the combination of ampicillin (for Listeria monocytogenes and GBS) plus cefotaxime (for gram-negative enteric organisms including E. coli) is the recommended empirical regimen. Ampicillin plus gentamicin is adequate for sepsis without meningitis but gentamicin has poor CNS penetration. Cefotaxime alone misses Listeria. Vancomycin is used if MRSA or resistant organisms are suspected but is not the first-line empirical choice for community-acquired neonatal meningitis.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.