We are inexorably entering an era where a wide range of multiply antibiotic-resistant bacteria are commonplace. Until recently, multiresistance was mainly seen in Gram-positive bacteria. However, vancomycin remains adequate as a treatment of most infections with these bacteria. The potential threat from vancomycin-resistant bacteria has never fully materialised, and now there is a growing number of new anti-Gram-positive antibiotics. Of these, there is sufficient experience of using linezolid and daptomycin in neonates for these drugs to be recommended for some specific indications. The recent rapid international spread of multiresistant Gram-negative bacteria, including carbapenem-resistant strains, is much more ominous. Treatment options are extremely limited, which has prompted renewed interest in older and more toxic antibiotics such as colistin. However, the optimal management of serious neonatal infections with these bacteria remains to be determined.
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