This protocol addresses tularemia arising in the neonatal period — specifically full-term infants aged 28 days or younger, and infants born prematurely who have reached 37 to 44 weeks postmenstrual age. Age and gestational maturity are the defining features of this population and directly shape treatment selection.
Neonates represent a distinct population for tularemia management. The definition includes full-term infants up to 28 days of life, as well as premature infants whose postmenstrual age has reached 37–44 weeks — aligning gestational maturity with the term-equivalent threshold.
For neonates in this age group, alternative antibiotic agents are available when first-line options are not suitable. The choice among alternatives depends in part on whether intravenous access can be established — when it cannot, one agent from the alternative group may be administered via a different route if a nasogastric tube is in place.
For these recommendations, neonates are defined as full-term infants aged ≤28 days or infants born premature who have reached 37–44 weeks postmenstrual age.
Levofloxacin, amikacin, tobramycin, and doxycycline can be used as alternative options.
If IV access cannot be obtained, doxycycline can be administered orally to neonates for treatment of tularemia if a nasogastric tube has been placed.
View source ↗