Omphalitis Medication

Updated: May 20, 2019
  • Author: Patrick G Gallagher, MD; Chief Editor: Santina A Zanelli, MD  more...
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Medication

Medication Summary

A combination of parenterally administered antistaphylococcal penicillin and an aminoglycoside antibiotic is recommended for uncomplicated omphalitis. Intravenous antimicrobial therapy with clindamycin or metronidazole may be indicated in some cases. 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.

Application of antimicrobial agents to the cord is appropriate in resource poor settings where the risk of omphalitis and its complications are high. In these cases, antimicrobial agents applied to the umbilicus have been shown to decrease bacterial colonization and to prevent omphalitis and associated complications.

Several effective umbilical cord care regimens are available, including the following:

  • Triple dye applied once daily until cord separation

  • Triple dye applied once, then alcohol applied daily until cord separation

  • Triple dye applied once, then no further antimicrobial treatment

  • Povidone-iodine, silver sulfadiazine, or bacitracin ointment applied daily until cord separation

  • Chlorhexidine 4% applied once, with no further antimicrobial treatment

  • Chlorhexidine 4% applied daily until cord separation

  • Salicylic sugar powder (97% powdered sugar, 3% salicylic acid) applied daily until cord separation

Topical therapy is also commonly used in attempts to control outbreaks of omphalitis.

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

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. [65]

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.

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