A Review of Antibiotic Used in Suspected Early-Onset Neonatal Sepsis From Malaysian Perspective: Which Ones to Choose and How Long to Give?

Abstract

Objective: Suspected early-onset sepsis is a common diagnosis among neonates which warrants admission to the neonatal intensive care unit. Prolonged empiric antibiotic is the biggest concern and treatment duration is still controversial. Antimicrobial stewardship (AMS) program promotes early antibiotic de-escalation to reduce unnecessary antibiotic exposure and its implementation in the intensive care setting seems to be feasible. The primary objective of this review was to compare the existing guidelines and review the literature regarding choice and duration of empiric antibiotic in managing suspected early-onset neonatal sepsis.Methods: Two Malaysian Ministry of Health guidelines were compared with guidelines from America (n=1), Australia (n=1), and United Kingdom (n=2). The literature search was conducted from January to June 2017 through open access journal and databases available at the author’s institution library (EBSCOHost, Ovid and Science Direct).Results: All guidelines recommended similar antibiotics range and suggested to review treatment at 36– 72 h post antibiotic exposure. A total of 113 abstracts and full articles were identified, and only 11 full-text articles published in English were related to the subject of interest. All studies show differences either in study design, choice of antibiotics, treatment duration or outcome measures; thus, a meta-analysis was not possible to be conducted.Conclusion: From this review, we found the potential to performed early empiric antibiotic de-escalation especially in clinically well-appearance neonates, and it is best to customize our guidelines based on local evidence which justify the need for more local research in this area.

Effect of antibiotics in the first week of life on faecal microbiota development

“…The long-term microbiota effect of ABs and its associated negative health outcomes reinforce the need for implementing AB stewardship programs53–55 to avoid AB overuse 21 56 57. The microbiota perturbations were only significant after 5–7 days compared with 2–3 days AB which could explain previous findings from the INCA cohort: namely higher incidence of infantile colic, wheezing and food allergies in infants exposed for 5–7 days, but not for 2–3 days 10 58.…”

An Updated Review on the Application of Dendrimers as Successful Nanocarriers for Brain Delivery of Therapeutic Moieties

“…2 shows the PAMAM dendrimers of two generations (G2 and G3) with different positive charges were attached to the streptavidin core through biotin click chemistry [100]. The study successfully demonstrated the improved ability of the protein molecule to cross the BBB by transcytosis via the endosomal pathway with high biocompatibility proving a new flexible nanoplatforms for the delivery of biopharmaceuticals can be hopefully developed [102].…”