bimalc Posted June 13, 2018 Share Posted June 13, 2018 What are folks using as empiric antibiotics for NEC in your local units? 2 Link to comment Share on other sites More sharing options...
Stefan Johansson Posted June 13, 2018 Share Posted June 13, 2018 Got this on Twitter 1 Link to comment Share on other sites More sharing options...
Stefan Johansson Posted June 13, 2018 Share Posted June 13, 2018 The Stockholm practise is meropenem (as monotherapy) Prev cefotax and an aminoglyk was first line treatment (+ metronidazol usually...) 1 Link to comment Share on other sites More sharing options...
Guest marcydf Posted June 15, 2018 Share Posted June 15, 2018 Ampicillin (200 mg/kg), gentamicin and metronidazole even if no perforation. Link to comment Share on other sites More sharing options...
egiannon Posted June 15, 2018 Share Posted June 15, 2018 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. 1 Link to comment Share on other sites More sharing options...
Padkaer Posted June 15, 2018 Share Posted June 15, 2018 In Aarhus (as tweeted) Ampi/Cefuroxim, gentamycin and metronidazole 😊. We are considering a switch to meropenem though. What are your experience with this Stefan ? Link to comment Share on other sites More sharing options...
harnon Posted June 15, 2018 Share Posted June 15, 2018 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 Link to comment Share on other sites More sharing options...
vidwans Posted June 15, 2018 Share Posted June 15, 2018 Ampicillin, Gentamicin. Couple of surgeons also want babies started on Clindamicin in severe NEC. Link to comment Share on other sites More sharing options...
gmustafa Posted June 15, 2018 Share Posted June 15, 2018 We usually use Ampicillin and Gentamicin. If perforation then add flagyl. If patient detoriates then switch to meropenem. 1 Link to comment Share on other sites More sharing options...
M C Fadous Khalife Posted June 15, 2018 Share Posted June 15, 2018 Cefotaxime , amikacin and flagyl but in case of deterioration , we broaden spectrum (Lebanon) Link to comment Share on other sites More sharing options...
kishoreyv17 Posted June 16, 2018 Share Posted June 16, 2018 Ampicillin and Gentamicin in our unit, 2nd line is Cefotaxime and amikacin (level 3 unit in India). 1 Link to comment Share on other sites More sharing options...
jhabibullah Posted June 16, 2018 Share Posted June 16, 2018 Tazocin & Amikacin/Gentamicin. In case of perforation add Flagyl. If baby is in impending shock relplace Tazocin with Meropenem. 1 Link to comment Share on other sites More sharing options...
Abdul kasim jaleel ahmed Posted June 17, 2018 Share Posted June 17, 2018 Hi all in this scenario we tried Amox + amikacin+Clindamycin Link to comment Share on other sites More sharing options...
fitain Posted June 17, 2018 Share Posted June 17, 2018 We use tazocin,amikacin Link to comment Share on other sites More sharing options...
Dr Ashish Jain Posted June 17, 2018 Share Posted June 17, 2018 Piperacillin+Tazo along with Meropenam ... Metro only if perforation Link to comment Share on other sites More sharing options...
Stefan Johansson Posted June 18, 2018 Share Posted June 18, 2018 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. Link to comment Share on other sites More sharing options...
M C Fadous Khalife Posted June 19, 2018 Share Posted June 19, 2018 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? Link to comment Share on other sites More sharing options...
Stefan Johansson Posted June 19, 2018 Share Posted June 19, 2018 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" Link to comment Share on other sites More sharing options...
M C Fadous Khalife Posted June 19, 2018 Share Posted June 19, 2018 Thx Dr johanssen Link to comment Share on other sites More sharing options...
Hamed Posted June 20, 2018 Share Posted June 20, 2018 Empirically in both NICUs in Japan and Canada ampicillin and aminoglycoside: (Gentamycin in Japan & Tobramycin in Canada). 1 Link to comment Share on other sites More sharing options...
kishoreyv17 Posted June 26, 2018 Share Posted June 26, 2018 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. Link to comment Share on other sites More sharing options...
wodi Posted July 2, 2018 Share Posted July 2, 2018 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? Link to comment Share on other sites More sharing options...
bimalc Posted July 9, 2018 Author Share Posted July 9, 2018 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 Link to comment Share on other sites More sharing options...
vvegamontes1 Posted August 9, 2018 Share Posted August 9, 2018 Empirically Ampi/Amika.... Link to comment Share on other sites More sharing options...
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