Empiric Antibiotics for NEC

[bimalc]

What are folks using as empiric antibiotics for NEC in your local units?

[Stefan Johansson]

Got this on Twitter

 

 

 

 

 

[Stefan Johansson]

The Stockholm practise is meropenem (as monotherapy)

Prev cefotax and an aminoglyk was first line treatment (+ metronidazol usually...)

[Guest marcydf]

Ampicillin (200 mg/kg), gentamicin and metronidazole even if no perforation.

[egiannon]

We also use ampicillin and gentamicin and add metronidazole  in case of perforation. We very rarely have positive blood cultures at the onset of NEC so we usually stick with this regimen. But it can be difficult to resist the temptation of broadening spectrum in patients that deteriorate.

[Padkaer]

In Aarhus (as tweeted) Ampi/Cefuroxim, gentamycin and metronidazole 😊. We are considering a switch to meropenem though. What are your experience with this Stefan ?

[harnon]

We will start empirically, the same antibiotics as we use for late onset sepsis=Tazobactam+piperacillin, Tazocin, and only after isolation of specific bacteria from blood we will narrow our treatment as apporpriate

[vidwans]

Ampicillin, Gentamicin. Couple of surgeons also want babies started on Clindamicin in severe NEC.

[gmustafa]

We usually use Ampicillin and Gentamicin. If perforation then add flagyl. If patient detoriates then switch to meropenem.

[M C Fadous Khalife]

Cefotaxime , amikacin and flagyl but in case of deterioration , we broaden spectrum (Lebanon) 

[kishoreyv17]

Ampicillin and Gentamicin in our unit, 2nd line is Cefotaxime and amikacin (level 3 unit in India). 

[jhabibullah]

Tazocin & Amikacin/Gentamicin. In case of perforation add Flagyl. If baby is in impending shock relplace Tazocin with Meropenem.

 

[Abdul kasim jaleel ahmed]

Hi all 

in this scenario we tried 

Amox + amikacin+Clindamycin

[fitain]

We use tazocin,amikacin

[Dr Ashish Jain]

Piperacillin+Tazo along with Meropenam ... Metro only if perforation 

 

[Stefan Johansson]

On 6/15/2018 at 3:05 PM, Padkaer said:

In Aarhus (as tweeted) Ampi/Cefuroxim, gentamycin and metronidazole 😊. We are considering a switch to meropenem though. What are your experience with this Stefan ?

I don't know if/how things have improved after the change. And since I left Karolinska a few years ago (for "the other hospital" ) I don't know the exact rationale. Will lunch with @Alexander Rakow tomorrow, will ask him for details.

OT and IMHO: But despite using almost only breast milk (donated or expressed) for very preterm infants, NEC is a reality around here   A fact that is the driving force for the academic startup Neobiomics I started with a few EU-based colleagues.

[M C Fadous Khalife]

From the above , I like  the idea of Dr johansson about giving only one antibiotic instead of keeping with 3 to 4 antibiotics; can we discuss using meropenem only for NEC? 

Do we have infectious disease neonatologists in the team? I always feel like keeping meropenem for the next step , but using 4 antibiotics is not the best option even if most of us are doing so . What do you think?

[Stefan Johansson]

Although it seems more simple with one antibiotic, it may not be the best strategy, for reasons related to resistance development.

Carbapenems (like meropenem) are typically used as the treatment option when other antibiotics fails due to (known or assumed) resistance. So, depending on the bacteriological context, it may or may not be a reasonable 1st-line choice. And carbapenem resistance is worrysome thing for health care beyond the NICU.

So, a reasonable bottomline would be along the lines "If it works, don't fix it"

 

[M C Fadous Khalife]

Thx Dr johanssen 

[Hamed]

Empirically in both NICUs in Japan and Canada ampicillin and aminoglycoside: (Gentamycin in Japan & Tobramycin in Canada).

[kishoreyv17]

On 6/19/2018 at 9:54 AM, M C Fadous Khalife said:

From the above , I like  the idea of Dr johansson about giving only one antibiotic instead of keeping with 3 to 4 antibiotics; can we discuss using meropenem only for NEC? 

Do we have infectious disease neonatologists in the team? I always feel like keeping meropenem for the next step , but using 4 antibiotics is not the best option even if most of us are doing so . What do you think?

Our microbiologist does not suggest monotherapy in neonates. Possibility of resistance. Also, aminoglycosides have synergisitic action with meropenem. 

[wodi]

We use meropenem + vancomycin + metronidazol (our microbiologist would be happy with meropenem only), for two to three weeks depending on bell stage or on clinical improvement or on 'gut feeling'.

How long do you treat for and for how long do you keep them NPO?

[bimalc]

On 7/2/2018 at 12:34 PM, wodi said:

How long do you treat for and for how long do you keep them NPO?

2 weeks

[vvegamontes1]

Empirically Ampi/Amika....