Switch Therapy in Full-Term Neonates with Presumed or Proven Bacterial Infection

Abstract

This case-control study of full-term newborns with presumed or proven bacterial infection compared the efficacy, safety and tolerability of switch antibiotic therapy and traditional completely intravenous antibiotic administration. there were 36 newborns treated with switch therapy (i.v. ampicillin + sulbactam combined with i.v. amikacin for 3 days followed by oral cefpodoxime proxetil for 5 days); there were 72 full-term newborns with the same characteristics as controls who received i.v. ampicillin + sulbactam combined with i.v. amikacin for 3 days followed by i.v. ampicillin + sulbactam alone for a further 5 days. the results showed that full-term newborns with presumed or proven bacterial infection initially treated with intravenous antibiotics can be switched to oral antibiotics after 3 days' therapy if physical and laboratory data indicate the disappearance of infection, thus significantly reducing the length of stay in the neonatal intensive care unit and significantly increasing breastfeeding, without having any negative clinical impact.

Oral antibiotics for neonatal infections: a systematic review and meta-analysis

“…Outcomes were comparable for the two groups, with identical inflammatory parameters in the first week of treatment and no mortality after 1 month. Admission duration was significantly lower and breastfeeding rate was significantly higher among neonates with an oral switch 41 …”

“…The remaining 27 studies included subjects with a clinical condition requiring antibiotics, ranging from prophylactic use to culture-proven infection. Two studies evaluated oral switch therapy in neonates with culture-proven sepsis 31 , 41 . Thirteen studies were performed in LMICs.…”

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

“…39 The empiric use of cephalosporins is discouraged due to an increased risk for the development of resistance and candidiasis; however, cephalosporins may be indicated if gram-negative meningitis is suspected. [69][70][71][72] For empiric third-generation cephalosporin therapy in neonates, cefotaxime is preferred over ceftriaxone due to the potential displacement of bilirubin and potential for kernicterus observed with ceftriaxone.…”

Scientific Rationale for Study Design of Community-based Simplified Antibiotic Therapy Trials in Newborns and Young Infants With Clinically Diagnosed Severe Infections or Fast Breathing in South Asia and sub-Saharan Africa

“…3 Very severe pneumonia in older children has been treated with 7 days of injectable antibiotics with good results, 41 whereas severe pneumonia has been treated with 5 days of oral antibiotics. 42 Switch therapy of injectable to oral antibiotics has been demonstrated to be efficacious for treatment of serious infections in neonates 18 and in older children. 43 For young infants with clinical severe infection included in this study, IM procaine penicillin will be used in a dose of 50,000 units/kg once daily IM and IM gentamicin in a 4–7.5 mg/kg/day once daily dose IM (depending on weight band of the young infant).…”