Choosing the right antibiotic and antifungal

Dr. Srilal De Silva

Dr. Srikanth Giri

Dr. Poonam Dalal

Dr. Arun Shah

Dr. Jatinder

Dr. Prakash Sanghvi

Moderator : Arvind Shenoi

More than 50 publications/presentations(National/International)

Certified instructor: FBNC, Basic & Advanced NRPand Indian Academy of Pediatrics (IAP)-ALS, IAP-ALS-MAP

Co-investigator: Nation-wide project titled

Dr. Poonam DalalMBBS, MD (Pediatrics)

Professor, Deptt of PediatricsPt. BDS, PGIMS, Rohtak, Haryana

Special Interest: NEONATOLOGY

CV- Dr Prakash SanghaviName : Dr. Prakash B. Sanghavi

Qualification : MB , DCH, FCPS (Ped. ) MNAMS, FIAP

Designation : Neonatologist & Pediatrician ,

Vice President - COMHAD International (Asia)

Ex- President - COMHAD India Chapter

Ex President - Maharashtra – NNF

Chairman – Swastik - Komal Health Care Limited

Chairman – Sanghavi Hospital , Kolhapur

National Co-ordinator – NALS

National Co-ordinator - KMC

Institution : Sanghavi Hospital & Premature Baby Care Centre, Kolhapur.

Swastik - Komal Health Care Limited, Kolhapur.

Area of Interest : Research In Neonatology

Prevention of Developmental Disability

Community Neonatology

Early Intervention in Developmental Disability

Publications : Maternal & Child Health Care, Vaccination, New-born Care, Prematurity,

Breast feeding, New-born Feeding, Neonatal sepsis,, Genetic Disorders,

New-born screening, Cerebral Palsy, literatures on Polio Eradication Programs.

Awards: Many Awards in Special Innovations in Neonatology,

FIAP by Indian Academy of Pediatrics

Head of Pediatric Department (Prasad Hospital)

Consultant Pediatrician Muzaffarpur

Dr Arun ShahMD DCH FRCP FIAP FNNF FIAMS

Area of interest : Neonatology

Arvind Shenoi

Consultant neonatologist and Medical DirectorCloudnine Hospital Bangalore

MD (Pediatrics) DM Neonatology(PGIMER)

Neonatal sepsis, Vitamin D in neonatal nutrition

Learning objectives

• Early onset and late onset sepsis

• Multi-drug resistant sepsis

• When to fungal infection/ mixed infection?

• Fungal meningitis & arthritis

• Culture negative sepsis

Case 1

• A 35 week 1.3 kg male neonate – 36 hours ROM, foul smelling liquourwith a mother with febrile UTI

• What antibiotic/s and why

• GBS – do you screen ? Role of prophylaxis

• When not to give antibiotics ?

Case 2

• Full term 2.3 Kg female neonate – admitted to NICU with hypoglycemia, feeding issues, worsened on day 5 with signs of shock, tachypnea and increasing feed intolerance.

• Which antibiotic?

• Will you consider an antifungal?

• If this neonate was 2 weeks old and had oral thrush

Case 3

• Baby born in a peripheral hospital- 2.7kg term, had respiratory distress at birth – given iv fluids, oxygen.

• Deteriorated on the 4 th day, shifted to your NICU

• Blood c/s Acinetobacter – R to Ampicillin, Amikacin, Gentamicin, carbepenems, & cephalosporins

• What antibiotic to use?

Case 4

• 1.2 kg neonate born at a small hospital in rural area, had respiratory distress treated with hood oxygen and iv fluids given ceftazidime and amikacin.

• Deteriorated on day 3 with shock and bleeding started on meropenem and Piperacillin and vancomycin

• Referred to your NICU on day 4

• Which antibiotic to give

• Culture negative

Case 5

• A 40 day ex 28 week ( CGA 34 week) recovering from NEC on Ceftazidine and Amikacin developed increasing lethargy.

• Which antibiotic?

• When will you consider fungal infection?

• Urine shows fungal hyphae

• CSF – suspicion of fungal invasion

• Ankle Joint swelling noted 2 days later

Key messages

• When not to give antibiotics

• EOS and LOS

• MDR organisms – concept of reserve antibiotics

• Fungal sepsis

• Oral thrush as a pointer to fungal colonization

• Therapy for fungal septicemia, meningitis, arthritis