Results of a two-center, before and after study of piperacillin–tazobactam versus ampicillin and gentamicin as empiric therapy for suspected sepsis at birth in neonates ⩽1500 g

Chong, Euming; Reynolds, Jane; Shaw, Jonathan E.; Forur, Lindsey; Delmore, Paula; Uner, Hasmet; Bloom, Barry T.; Gordon, Phillip V.

doi:10.1038/jp.2012.169

Cited by 16 publications

(11 citation statements)

References 21 publications

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“…Patients receiving AG had a lower GFR, consistent with our previous study in which this was transient and not sustained. 1 We did not abstract GFR beyond the exposure period. There are some limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Antenatal exposure and prolonged postnatal ampicillin exposure increase the risk of necrotizing enterocolitis (NEC). [1][2][3][4][7][8][9] In addition, ampicillin increases bleeding times through a direct effect on platelets. 1 However, the most important concerns are ototoxic and renal toxic effects of gentamicin, gentamicin resistance in late onset infection and emergence of ampicillin and gentamicin resistant E. coli.…”

Section: Haemophilus Influenza and Citrobacter Speciesmentioning

confidence: 99%

“…PT was associated with a transient increase in glomerular filtration rate during exposure and decreases in NEC and diaper rash when compared with AG. 1 Therefore, a study was designed to assess whether PT was associated with altered outcomes in infants with greater than 1500 grams birth weight.…”

Section: Haemophilus Influenza and Citrobacter Speciesmentioning

confidence: 99%

“…The most prevalent gram positive organism is Group B Streptococcus, although this organism has been in decline coinciding with increased intrapartum ampicillin. [1][2][3][4] The most frequent gram negative bacteria are Escherichia coli, followed by…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness and Safety of Empiric Ampicillin plus Gentamicin or Empiric Piperacillin-Tazobactam in the Neonatal Intensive Care Unit

Smith

Ahlers-Schmidt²,

Bloom³

2015

kjm

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Background. This study was designed to assess piperacillin tazobactam (PT) as an alternative to ampicillin and gentamicin (AG) in neonates with suspected systemic infection. Methods. A retrospective, unmatched population of AG (2007)(2008)(2009) and PT (2009-2012) exposed infants were evaluated for initial effectiveness, adverse events, and subsequent morbidities or mortality. Data included gestational age, birth weight, sex, Apgar score, length of hospital stay, glomerular filtration rate for days 1 and 2, duration on mechanical ventilation, duration on oxygen therapy, incidence of sepsis (blood or cerebrospinal fluid culture positive), incidence of ventilator associated pneumonia, and incidence of necrotizing enterocolitis. All positive blood cultures during the study period were reviewed. Data about specific microorganisms and sensitivity to antibiotics were collected. Results. No significant differences in demographics or initial Apgar scores were noted. There were no significant differences in systemic rash or diaper rash. PT was associated with higher glomerular filtration rate on day two. Four infants had early onset sepsis with ampicillin resistant E. coli. One of these, in the PT group, had intermediate sensitivity to gentamicin as well. Conclusion. Use of PT as the initial empiric antibiotic was not associated with increased adverse outcomes. The challenge of ampicillin resistant Escherichia coli should encourage others to consider this change. KS J Med 2015; 8(2):80-83.

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Section: Discussionmentioning

confidence: 99%

Section: Haemophilus Influenza and Citrobacter Speciesmentioning

confidence: 99%

Section: Haemophilus Influenza and Citrobacter Speciesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative Effectiveness and Safety of Empiric Ampicillin plus Gentamicin or Empiric Piperacillin-Tazobactam in the Neonatal Intensive Care Unit

Smith

Ahlers-Schmidt²,

Bloom³

2015

kjm

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“…Only 6 articles compared endpoint of two different treatments. Four studies compared two different treatment combinations (ampicillin plus gentamicin vs. piperacillin-tazobactam; ampicillin plus gentamicin versus C-penicillin plus gentamicin; ampicillin plus cefotaxime versus ampicillin plus gentamicin; and ampicillin plus aminoglycosides versus C-penicillin plus aminoglycosides) [21,25,26,55]. One study compared two different monotherapies (amikacin vs. piperacillin-tazobactam) [54].…”

Section: Choice Of Empiric Antibiotic Regimementioning

confidence: 99%

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

Ibrahim¹,

Makmor‐Bakry

Ishak

et al. 2019

Asian J Pharm Clin Res

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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.

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Antimicrobial Treatment of Serious Gram-Negative Infections in Newborns

Gray

Ubhi

Milner

2014

Curr Infect Dis Rep

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The choice of antibiotics for serious Gram-negative bacterial infections in the newborn must balance delivery of effective antibiotics to the site(s) of infection with the need to minimize selection of antibiotic resistance. To reduce the risk of selective pressure from large-scale cephalosporin usage, a penicillin-aminoglycoside combination is recommended as empiric therapy for neonatal sepsis. Where Gram-negative sepsis is strongly suspected or proven, a third-generation cephalosporin should ordinarily replace penicillin. Piperacillin-tazobactam can provide better Gram-negative cover than penicillin-aminoglycoside combinations, without the risk of selecting antibiotic resistance seen with cephalosporins, but further clinical studies are required before this approach to empiric therapy can be recommended. For antibiotic-resistant infections, a carbapenem remains the mainstay of treatment. However, rapid emergence and spread of resistance to these antibiotics means that in the future, neonatologists may have to rely on antibiotics such as colistin, whose pharmacokinetics, safety, and clinical efficacy in neonates are not well-defined.

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Results of a two-center, before and after study of piperacillin–tazobactam versus ampicillin and gentamicin as empiric therapy for suspected sepsis at birth in neonates ⩽1500 g

Cited by 16 publications

References 21 publications

Comparative Effectiveness and Safety of Empiric Ampicillin plus Gentamicin or Empiric Piperacillin-Tazobactam in the Neonatal Intensive Care Unit

Comparative Effectiveness and Safety of Empiric Ampicillin plus Gentamicin or Empiric Piperacillin-Tazobactam in the Neonatal Intensive Care Unit

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

Antimicrobial Treatment of Serious Gram-Negative Infections in Newborns

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