Antibiotic choices , please share your experience

[Aymen Eshene]

hi every one , 

on which base you choose one antibiotic over the other ? is there any local activity should be done with the help of microbiologist in order to formulate some combination which suit Nicu enviroment?? i know that most nicu choose ampicillin and claforan or gentamicin as first line of defense  , but in case of failed therapy and no supportive information gained by blood culture , how can we choose the second line ???

where i do work we move ((empirically ) to our second line meronam and vancomycin but i feel this combination is to stronge to be used as second line and iam wondering what other combination can be used instead of this powerfull antimicrobe(fear of resistance of course) .

our third line is amikacin and ceftazidine , but again , usualy we jump to this line with full of hope to kill the microbs but as you know hope alone is not microbicidal !!

so is there any universal roles to be followed or ita based mainly on clinical background and the available data ?

any answers on questions ??

 

thanks in advance

[rehman_naveed]

Hi ayemen

there is no universal rule . But to use meropenem as 2nd line is not at all allowed.

but it all depends on baby condition. In case of septic shock , yes you can use big guns but for routine rule out sepsis ( most of NICU admission) don't change antibiotics unless blood cs comes positive and narrow down the antibiotics.

it is very rare to grow gram negatives after 24 hrs of culture with modern techniques , so gram negatives should be discontinued after 24 hrs provided clinical and lab evidence are normal and then also DC gram positive later at 48 hrs.

i hope it helps and answer your question 

naveed

[Aymen Eshene]

hi ..

thanks for the information , we get used to change to meronam and vancomycin , ans as you said its too big decision for most of nicu admition .

 

[rehman_naveed]

Use vancomycin if line sepsis is suspected and only if cs grow s epidermidis that is resistant to clox otherwise for LOS clox and tobramycin coverage is enough. Also don't use too frequent cefotaxime , it will create much problem in terms of resistant bugs. Use only when meningitis is strongly suspected and u can't do LP due to sick baby etc.

we use meropenem rarely.

 

[Aymen Eshene]

thanks a lot ,, 

 

[M C Fadous Khalife]

Our first line antibiotics are Ampicillin and cefotaxime 

Meropenem comes in 3rd line

Vancomycine is a 2nd line choice if he have a central line 

Amikin is usually used just for 48h till we are sure of our cultures results 

 

Sorry ampicillin and /or cefotaxime

 

[sueprul]

Anyone using Cipro as second line. In the country I volunteer in Africa I see the switch to cipro most often now? 

[agoz]

ampiciline + gentamycine are our  first line antibiotics.

[M C Fadous Khalife]

Ampi and genta first line 

[gmustafa]

For early onset sepsis, we use Ampicillin and Gentamicin. If baby is “very sick” then we add Cefotaxime to broaden the gram negative coverage. Few years back we had been using Ampicillin and Cefotaxime as first line drug but then we saw emergence of ESBL K. pneumonia so we stopped using it. For late onset sepsis we use Oxacillin and Amikacin. If patient is “very sick” then we use meropenem. If chest xray is positive or patient has central line then we add Vancomycin.