The use of ciprofloxacin and fluconazole in Italian neonatal intensive care units: a nationwide survey

A standardized and previously tested questionnaire was submitted online to all Italian level III NICUs. A 5-point Likert scale was used to analyze attitudinal replies. Categorical variables were compared by χ2 analysis and 2-tailed P-values are reported.Data was provided by 38 Italian NICUs (36% of the country’s level III centers), 53% of which have 1–10 cases of bacterial sepsis monthly and 90% a prevalence of <1% fungal infections. Ciprofloxacin and fluconazole treatment for neonatal sepsis are scantly used in Italian NICUs (13% and 45%, respectively). Major concerns are related to the safety of ciprofloxacin and the efficacy of fluconazole. On the contrary, prophylaxis of fungal infections is a routine approach in many Italian NICUs. The use of both ciprofloxacin and fluconazole is characterized by a large inter-NICU variability in dose and scheme of use. The lack of adequate, shared evidence is a common consideration made by the survey participants.Common approaches are needed to standardize and update a national drug strategy for the prevention and treatment of sepsis in very low birth weight newborns. This can be achieved through collaborative initiatives aimed at setting up guidelines, based on available data, and multicenter trials to produce new evidence that will address the knowledge gaps.Sepsis in neonates can be caused by bacterial or fungal microorganisms and is associated with significant morbidity and mortality. Up to one fourth of very-low-birth weight infants (VLBW; <1500 g at birth) develop hospital-acquired infections.Studies have assessed the use prophylactic measures to prevent infections, but data on treatment and prophylaxis is lacking [1-3]. Empirical antibiotic therapy is often used in NICUs [4], although it can lead to unnecessary exposure to antibiotics, can increase the risk of neonatal death, and can cause selective pressure for antibiotic resistance, making it fundamental to employ only the best possible options and only when necessary