It is appreciable effort on part of Saini, et al. [1], to cut short the usage of antibiotics in case of culture negative "sepsis" but we have some observations regarding the study.

A complete sepsis screen score should have been taken into consideration before deciding to start the antibiotics. CRP alone with clinical suspicion will lead to falsely high number of neonates getting enrolled which will affect the primary outcome as these ‘false positive’ cases are less likely to present with’ treatment failure [2]. Sepsis score not relying upon ‘CRP alone’ would have been more useful as this costly test is not universally available, as mentioned by the authors also.

Babies falling sick within fifteen day period are presumed to be the continuum of initial episode while a re-infection or sepsis caused by different organism cannot be ruled out completely. The number of neonates who were labeled as ‘treatment failure’ will be inflated falsely because of re-infection/fresh sepsis. It is not possible to ensure equal distribution of these fresh cases in both groups as sample size is very small. So the conclusion drawn that the short course antibiotics is not harmful can not be validated adequately even by this pilot study.

References

2. Edwards MS. Immune system (part2) –postnatal bacterial infections. In: Martin RJ, Fanaroff AA, Walsh MC (editors). Fanaroff and Martin’s Neonatal and Perinatal Medicine-Diseases of Fetus and Infant. 8th ed. Philadelphia: Elsevier Mosby; 2006.p.798.