A term neonate develops severe respiratory distress at 4 hours of life. Chest X-ray shows a diffuse granular pattern with air bronchograms in both lung fields. Blood culture is pending. The mother had a temperature of 38.5 degrees Celsius during labor. What is the MOST appropriate initial empiric antibiotic regimen?

• A Ampicillin and gentamicin ✓
• B Ceftriaxone alone
• C Vancomycin and meropenem
• D Piperacillin-tazobactam alone

Explanation

The clinical picture suggests early-onset neonatal sepsis or pneumonia. The standard empiric regimen is ampicillin plus gentamicin. This combination covers the most common organisms including group B Streptococcus, Escherichia coli, and Listeria monocytogenes. Ceftriaxone is avoided in neonates due to kernicterus risk, and vancomycin-meropenem is reserved for suspected late-onset sepsis with resistant organisms.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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