Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Omphalitis Medication

  • Author: Patrick G Gallagher, MD; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jan 02, 2016
 

Medication Summary

A combination of parenterally administered antistaphylococcal penicillin and an aminoglycoside antibiotic is recommended for uncomplicated omphalitis. Some believe that anaerobic coverage also should be considered in all infants with omphalitis. Omphalitis complicated by necrotizing fasciitis or myonecrosis requires a more aggressive approach, and antimicrobial therapy directed at anaerobic organisms, as well as gram-positive and gram-negative organisms, is suggested. Metronidazole may be added to the combination of antistaphylococcal penicillin and aminoglycoside to provide anaerobic coverage, or clindamycin may be substituted for antistaphylococcal penicillin. As with antimicrobial therapy for other infections, consider local antibiotic susceptibility patterns and results of blood and biopsy specimen culturing.

Blood products (eg, packed RBCs, platelets, fresh frozen plasma) and other medications (eg, inotropic agents, sodium bicarbonate) may be required for supportive care.

Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.[46]

Gentamicin (Garamycin)

 

Aminoglycoside antibiotic for gram-negative coverage. Used in combination both with an agent against gram-positive organisms and with an agent that covers anaerobes.

Oxacillin (Bactocill)

 

Antistaphylococcal penicillin. Bactericidal antibiotic that inhibits cell wall synthesis. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when staphylococcal infection is suspected.

Clindamycin (Cleocin)

 

Used to treat infections caused by anaerobic bacteria. Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest.

Metronidazole IV (Flagyl)

 

Anaerobic antibiotic that also has amebicide and antiprotozoal actions.

Ampicillin

 

Broad-spectrum penicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Bactericidal for organisms, such as GBS, Listeria, non-penicillinase-producing staphylococci, some strains of Haemophilus influenzae, and meningococci.

Vancomycin (Vancocin, Vancoled)

 

Bacteriocidal agent against most aerobic and anaerobic gram-positive cocci and bacilli. Especially important in the treatment of MRSA. Recommended therapy when coagulase-negative staphylococcal sepsis is suspected.

Previous
 
 
Contributor Information and Disclosures
Author

Patrick G Gallagher, MD Professor, Departments of Pediatrics, Pathology and Genetics, Division of Neonatal-Perinatal Medicine, Yale University School of Medicine and Yale-New Haven Children's Hospital

Patrick G Gallagher, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Clinical Investigation, American Society for Clinical Investigation, American Society of Hematology, Connecticut State Medical Society, Society for Pediatric Research, American Society of Human Genetics

Disclosure: Nothing to disclose.

Coauthor(s)

Samir S Shah, MD, MSc Director, Division of Hospital Medicine, Attending Physician in Hospital Medicine and Infectious Diseases, James M Ewell Endowed Chair, Cincinnati Children's Hospital Medical Center; Professor, Department of Pediatrics, University of Cincinnati College of Medicine

Samir S Shah, MD, MSc is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Shelley C Springer, JD, MD, MSc, MBA, FAAP Professor, University of Medicine and Health Sciences, St Kitts, West Indies; Clinical Instructor, Department of Pediatrics, University of Vermont College of Medicine; Clinical Instructor, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health

Shelley C Springer, JD, MD, MSc, MBA, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

References
  1. Cushing AH. Omphalitis: a review. Pediatr Infect Dis. 1985 May-Jun. 4(3):282-5. [Medline].

  2. Airede AI. Pathogens in neonatal omphalitis. J Trop Pediatr. 1992 Jun. 38(3):129-31. [Medline].

  3. Brook I. Microbiology of necrotizing fasciitis associated with omphalitis in the newborn infant. J Perinatol. 1998 Jan-Feb. 18(1):28-30. [Medline].

  4. [Guideline] Riley LE, Stark AR, eds. Guidelines for Perinatal Care. 7th ed. Elk Grove Village, IL, and Wash, DC: American Academy of Pediatrics and American College of Obstetricians and Gynecologists; 2012. 302.

  5. Karumbi J, Mulaku M, Aluvaala J, et al. Topical umbilical cord care for prevention of infection and neonatal mortality. Pediatr Infect Dis J. 2013 Jan. 32(1):78-83. [Medline]. [Full Text].

  6. [Guideline] WHO. Guidelines on Maternal, Newborn, Child and Adolescent Health: Recommendations on Newborn Health. Available at http://www.who.int/maternal_child_adolescent/documents/guidelines-recommendations-newborn-health.pdf. Accessed: Sep 29 2014.

  7. Imdad A, Bautista RM, Senen KA, et al. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst Rev. 2013 May 31. 5:CD008635. [Medline].

  8. Goldenberg RL, McClure EM, Saleem S. A review of studies with chlorhexidine applied directly to the umbilical cord. Am J Perinatol. 2013 Sep. 30(8):699-701. [Medline]. [Full Text].

  9. Imdad A, Mullany LC, Baqui AH, et al. The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis. BMC Public Health. 2013. 13 Suppl 3:S15. [Medline]. [Full Text].

  10. Sinha A, Sazawal S, Pradhan A, Ramji S, Opiyo N. Chlorhexidine skin or cord care for prevention of mortality and infections in neonates. Cochrane Database Syst Rev. 2015 Mar 5. 3:CD007835. [Medline].

  11. McKenna H, Johnson D. Bacteria in neonatal omphalitis. Pathology. 1977 Apr. 9(2):111-3. [Medline].

  12. Geil CC, Castle WK, Mortimer EA Jr. Group A streptococcal infections in newborn nurseries. Pediatrics. 1970 Dec. 46(6):849-54. [Medline].

  13. Gezon HM, Schaberg MJ, Klein JO. Concurrent epidemics of Staphylococcus aureus and group A Streptococcus disease in a newborn nursery. Control with penicillin G and hexachlorophene bathing. Pediatrics. 1973 Feb. 51(2):383-90. [Medline].

  14. Nelson JD, Dillon HC Jr, Howard JB. A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus. J Pediatr. 1976 Nov. 89(5):792-6. [Medline].

  15. Sawin RS, Schaller RT, Tapper D, et al. Early recognition of neonatal abdominal wall necrotizing fasciitis. Am J Surg. 1994 May. 167(5):481-4. [Medline].

  16. Ameh EA, Nmadu PT. Major complications of omphalitis in neonates and infants. Pediatr Surg Int. 2002 Sep. 18(5-6):413-6. [Medline].

  17. Feo CF, Dessanti A, Franco B, et al. Retroperitoneal abscess and omphalitis in young infants. Acta Paediatr. 2003. 92(1):122-5. [Medline].

  18. Fraser N, Davies BW, Cusack J. Neonatal omphalitis: a review of its serious complications. Acta Paediatr. 2006 May. 95(5):519-22. [Medline].

  19. Kosloske AM, Cushing AH, Borden TA, et al. Cellulitis and necrotizing fasciitis of the abdominal wall in pediatric patients. J Pediatr Surg. 1981 Jun. 16(3):246-51. [Medline].

  20. Lally KP, Atkinson JB, Woolley MM, Mahour GH. Necrotizing fasciitis. A serious sequela of omphalitis in the newborn. Ann Surg. 1984 Jan. 199(1):101-3. [Medline].

  21. Samuel M, Freeman NV, Vaishnav A, et al. Necrotizing fasciitis: a serious complication of omphalitis in neonates. J Pediatr Surg. 1994 Nov. 29(11):1414-6. [Medline].

  22. Moss RL, Musemeche CA, Kosloske AM. Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg. 1996 Aug. 31(8):1142-6. [Medline].

  23. Weber DM, Freeman NV, Elhag KM. Periumbilical necrotizing fasciitis in the newborn. Eur J Pediatr Surg. 2001 Apr. 11(2):86-91. [Medline].

  24. Nazir Z. Necrotizing fasciitis in neonates. Pediatr Surg Int. 2005 Aug. 21(8):641-4. [Medline].

  25. Bingol-Kologlu M, Yildiz RV, Alper B, et al. Necrotizing fasciitis in children: diagnostic and therapeutic aspects. J Pediatr Surg. 2007 Nov. 42(11):1892-7. [Medline].

  26. Mason WH, Andrews R, Ross LA, Wright HT Jr. Omphalitis in the newborn infant. Pediatr Infect Dis J. 1989 Aug. 8(8):521-5. [Medline].

  27. O'Brien PH, Meredith HC, Vujic I, Schabel SI. Obstructive jaundice caused by cavernous transformation of the portal vein post neonatal omphalitis. J S C Med Assoc. 1979 May. 75(5):209-10. [Medline].

  28. Perlemuter G, Bejanin H, Fritsch J, et al. Biliary obstruction caused by portal cavernoma: a study of 8 cases. J Hepatol. 1996 Jul. 25(1):58-63. [Medline].

  29. Orloff MJ, Orloff MS, Girard B, Orloff SL. Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years' experience with portal-systemic shunt. J Am Coll Surg. 2002 Jun. 194(6):717-28; discussion 728-30. [Medline].

  30. Hung CH, Cheng SN, Hua YM, et al. Leukocyte adhesion deficiency disorder: report of one case. Acta Paediatr Taiwan. 1999 Mar-Apr. 40(2):128-31. [Medline].

  31. Mogica-Martinez MD, Lopez-Duran JL, Canseco-Raymundo MR, Becerril Angeles M. [Leukocyte adhesion deficiency syndrome: case report]. Rev Alerg Mex. 1999 Sep-Oct. 46(5):140-4. [Medline].

  32. van Vliet DN, Brandsma AE, Hartwig NG. [Leukocyte-adhesion deficiency: a rare disorder of inflammation]. Ned Tijdschr Geneeskd. 2004 Dec 11. 148(50):2496-500. [Medline].

  33. Alizadeh P, Rahbarimanesh AA, Bahram MG, Salmasian H. Leukocyte adhesion deficiency type 1 presenting as leukemoid reaction. Indian J Pediatr. 2007 Dec. 74(12):1121-3. [Medline].

  34. Parvaneh N, Mamishi S, Rezaei A, et al. Characterization of 11 new cases of leukocyte adhesion deficiency type 1 with seven novel mutations in the ITGB2 gene. J Clin Immunol. 2010 Sep. 30(5):756-60. [Medline].

  35. Hagimoto R, Koike K, Sakashita K, et al. A possible role for maternal HLA antibody in a case of alloimmune neonatal neutropenia. Transfusion. 2001 May. 41(5):615-20. [Medline].

  36. Rezaei N, Moin M, Pourpak Z, et al. The clinical, immunohematological, and molecular study of Iranian patients with severe congenital neutropenia. J Clin Immunol. 2007 Sep. 27(5):525-33. [Medline].

  37. Dale DC. ELANE-Related Neutropenia. 1993. [Medline].

  38. Shim YJ, Kim HJ, Suh JS, Lee KS. Novel ELANE gene mutation in a Korean girl with severe congenital neutropenia. J Korean Med Sci. 2011 Dec. 26(12):1646-9. [Medline].

  39. Donadieu J, Fenneteau O, Beaupain B, Mahlaoui N, Chantelot CB. Congenital neutropenia: diagnosis, molecular bases and patient management. Orphanet J Rare Dis. 2011. 6:26. [Medline].

  40. Elhassani SB. The umbilical cord: care, anomalies, and diseases. South Med J. 1984 Jun. 77(6):730-6. [Medline].

  41. Boyle G, Rosenberg HK, O'Neill J. An unusual presentation of an infected urachal cyst. Review of urachal anomalies. Clin Pediatr (Phila). 1988 Mar. 27(3):130-4. [Medline].

  42. Ward TT, Saltzman E, Chiang S. Infected urachal remnants in the adult: case report and review. Clin Infect Dis. 1993 Jan. 16(1):26-9. [Medline].

  43. Razvi S, Murphy R, Shlasko E, Cunningham-Rundles C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics. 2001 Aug. 108(2):493-4. [Medline]. [Full Text].

  44. Masuko T, Nakayama H, Aoki N, Kusafuka T, Takayama T. Staged approach to the urachal cyst with infected omphalitis. Int Surg. 2006 Jan-Feb. 91(1):52-6. [Medline].

  45. Kosloske AM, Bartow SA. Debridement of periumbilical necrotizing fasciitis: importance of excision of the umbilical vessels and urachal remnant. J Pediatr Surg. 1991 Jul. 26(7):808-10. [Medline].

  46. Young TE, Mangum B. Neofax 2008. 21st edition. Thomson Reuters; 2008.

  47. Brook I. Anaerobic infections in children. Adv Exp Med Biol. 2011. 697:117-52. [Medline].

  48. Brook I, Dunkle LM. Anaerobic infections. McMillan J, De Angelis CD, Feigin RD, eds. Oski's Pediatrics: Principles and Practice. 3rd ed. Lippincott Williams & Wilkins; 1999. 937-50.

  49. Gormley D. Neonatal anaerobic (clostridial) cellulitis and omphalitis. Arch Dermatol. 1977 May. 113(5):683-4. [Medline].

 
Previous
Next
 
Anatomic relationship between the umbilicus and its embryologic attachments.
A case of omphalitis (left) associated with extensive myonecrosis (right).
A case of omphalitis associated with bullous impetigo due to Staphylococcus aureus.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.