🅰️
👉Early #antibiotic therapy and adverse outcomes in preterm infants: Time for a trial!
📌For decades, #antibiotics have been prescribed after delivery to preterm infants cared for in the neonatal intensive care unit. Given the risks of early-onset #sepsis, particularly during the peak of group B streptococcal disease, a “better safe than sorry” approach to empiric antibiotics became commonplace. Like Thetis dipping her newborn Achilles into the river Styx to confer invulnerability, neonatologists would routinely administer ampicillin and gentamicin for days or even weeks, often in the absence of any objective evidence for infection. As recently as 2008, approximately half of extremely-low-birth-weight (ELBW, <1000 g) infants received >5 days of empiric antibiotic therapy after delivery.
Unfortunately, as with Achilles, a critical weakness in that strategy was identified. In 2009, Cotton et al
associated prolonged early antibiotic therapy with an increased risk for necrotizing enterocolitis (NEC) and death in ELBW infants (OR 1.04 [95% CI 1.02-1.06] per day of antibiotics). A variety of other study groups in different centers and countries have since found similar associations.
Over the last 10 years, prolonged empiric antibiotic use among preterm infants has decreased, although more than a third of ELBW infants still receive prolonged empiric antibiotics.
🔗https://doi.org/10.1016/j.jpeds.2020.07.046
👉Early #antibiotic therapy and adverse outcomes in preterm infants: Time for a trial!
📌For decades, #antibiotics have been prescribed after delivery to preterm infants cared for in the neonatal intensive care unit. Given the risks of early-onset #sepsis, particularly during the peak of group B streptococcal disease, a “better safe than sorry” approach to empiric antibiotics became commonplace. Like Thetis dipping her newborn Achilles into the river Styx to confer invulnerability, neonatologists would routinely administer ampicillin and gentamicin for days or even weeks, often in the absence of any objective evidence for infection. As recently as 2008, approximately half of extremely-low-birth-weight (ELBW, <1000 g) infants received >5 days of empiric antibiotic therapy after delivery.
Unfortunately, as with Achilles, a critical weakness in that strategy was identified. In 2009, Cotton et al
associated prolonged early antibiotic therapy with an increased risk for necrotizing enterocolitis (NEC) and death in ELBW infants (OR 1.04 [95% CI 1.02-1.06] per day of antibiotics). A variety of other study groups in different centers and countries have since found similar associations.
Over the last 10 years, prolonged empiric antibiotic use among preterm infants has decreased, although more than a third of ELBW infants still receive prolonged empiric antibiotics.
🔗https://doi.org/10.1016/j.jpeds.2020.07.046
In this review, the authors highlight the current and future developments that could allow transition to a more precise manner of #antibiotic treatment in late preterm and term neonates, and propose a research agenda toward precision medicine for neonatal bacterial #infections.
doi.org/10.3389/fped.2021.590969
*The full text is here
doi.org/10.3389/fped.2021.590969
*The full text is here
#Antibiotic #stewardship programs can be effective for premature newborns especially when multifactorial and tailored to this population, focusing on reducing initiation or on shortening the duration of antibiotic therapy. Programs without specific measures were less effective.
doi.org/10.1159/000511710
*The full text is in the comments
doi.org/10.1159/000511710
*The full text is in the comments
In premature infants, complicated intraabdominal #infections (cIAIs) are a leading cause of morbidity and mortality.
Each of the #antibiotic regimens - ampicillin, gentamicin, and metronidazole (group 1); ampicillin, gentamicin, and clindamycin (group 2); or piperacillin-tazobactam and gentamicin (group 3) at doses stratified by postmenstrual age - are safe in premature infants with cIAI.
https://doi.org/10.1097/inf.0000000000003034
Each of the #antibiotic regimens - ampicillin, gentamicin, and metronidazole (group 1); ampicillin, gentamicin, and clindamycin (group 2); or piperacillin-tazobactam and gentamicin (group 3) at doses stratified by postmenstrual age - are safe in premature infants with cIAI.
https://doi.org/10.1097/inf.0000000000003034
Do you treat every positive urine culture in the NICU as a #UTI? Here is an algorithm to treat, and it decreased our #antibiotic use.
doi.org/10.1038/s41372-021-01079-6
*The full text is here https://t.co/xDXKlCT1p6?amp=1
doi.org/10.1038/s41372-021-01079-6
*The full text is here https://t.co/xDXKlCT1p6?amp=1