What is the recommended neonatal meningitis antibiotic regimen?

• A. Ceftriaxone alone
• B. Ampicillin alone
• C. Ceftriaxone plus ampicillin
• D. Cefotaxime plus ampicillin

Answer: (D)

In neonates with suspected meningitis, you need coverage for the organisms most common in this age group: Group B Streptococcus, Listeria, and gram-negative bacteria. Ampicillin is used to cover Listeria and GBS, while a drug with reliable CSF penetration to cover gram-negatives is added. Cefotaxime provides good CSF penetration and effectively covers gram-negative meningitis pathogens, whereas ceftriaxone is avoided in newborns because it can displace bilirubin and raise the risk of kernicterus. Put together, cefotaxime plus ampicillin gives the appropriate broad coverage and safe CSF levels for a neonatal meningitis regimen.