Two New Studies Highlight Ways To Reduce Antibiotic Use in NICUs

Findings indicate that antibiotics are often given to infants with suspected sepsis, even if the condition has not been confirmed, contributing to overuse of the medications.

March 14, 2025

Martha Garcia

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Health experts are warning about serious risks associated with antibiotic overuse in neonatal intensive care units (NICU), which can increase an infant’s risk of suffering late-onset sepsis or contracting antibiotic resistant bacteria, potentially leading to severe illnesses or death.

In two separate studies published last month in the medical journal Pediatrics, researchers indicate that putting in place guidelines like educational sessions, case audits and several other interventions could help reduce the overuse of antibiotics in infants by up to 80%.

NICU Antibiotic Prescriptions

Antibiotics are the most frequently prescribed drug in NICUs because infants born early typically face serious infections, even though data published in 2024 indicates that only about one-third of pediatric antibiotic prescriptions are given for legitimate infections.

Doctors’ prescribing habits are generally held up as the primary cause for infant antibiotic overuse. For example, antibiotics are often given to infants with suspected sepsis, even when the condition has not been confirmed.

For this reason, researchers are now suggesting new intervention methods are needed to help reduce unnecessary antibiotic use, which may be the best way to protect vulnerable infants from certain illnesses and death.

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BABY FORMULA NEC LAWSUITS

Was your premature child fed Similac or Enfamil?

Premature infants fed Similac or Enfamil cow’s milk formula face an increased risk of necrotizing enterocolitis (NEC) or wrongful death.

Learn More

SEE IF YOU QUALIFY FOR COMPENSATION

Reducing Antibiotic Overuse With Consensus Guidelines

The first study, conducted at the Pediatrics Department at St. Christopher’s Hospital for Children in Pennsylvania, developed and implemented an antibiotic stewardship quality improvement initiative and then monitored the results. A total of 552 infants were included in the analysis.

A multidisciplinary team conducted the study at a 39-bed level IV NICU facility. They used consensus guidelines with the goal of reducing antibiotic use by 20%.

The guidelines included limits on antibiotic duration for common indications, educational sessions, antibiotic stop dates, and antibiotic necessity documentation in the electronic health record to standardize doctor justification for antibiotic prescription and duration.

Across a four-year study period, antibiotic use decreased by 50%, with use dropping from 278 infants to 140 across the four years, according to the data. In addition, the use of antibiotics for culture-negative sepsis diagnoses fell by 64%, from 22 infants at the start to just eight by the study’s conclusion.

Researchers determined that using a standardized set of guidelines focused on evidence-based outcomes can help guide doctors to prescribe antibiotics less among infant patients who simply do not need the drugs.

Weekly Interventions To Reduce Overuse

A separate study was conducted by researchers from the Icahn School of Medicine at Mount Sinai, New York and focused on practices for reducing antibiotic overuse.

This study used antibiotic guidelines, case audits, weekly stewardship rounds and biweekly review of culture-negative sepsis cases at staff meetings. The initiative also included educational sessions, literature review and consensus discussions.

Researchers found that the interventions helped decrease the use of antibiotics for any reason by 24%. They determined the program also decreased antibiotic courses for culture-negative sepsis by 68% and decreased early-onset sepsis antibiotic use from 18.3 days to 3.9 days.

With regard to overall antibiotic days of therapy, use decreased from 232.5 days to 176.7 days of therapy, the researchers determined.

As a result, the research team concluded that by focusing on doctor interventions antibiotics were reduced in the long-term.

The most impactful intervention, according to researchers, was beginning weekly check-ins focused on proper antibiotic use to increase awareness of the importance of the program.

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