Antibiotic choice in 22 week babies

[dramitkan]

Dear All, 

I wanted to know your unit’s antibiotic choice in 22-23 week babies. We use Benzyl Penicillin and Gentamicin. Dose of Gentamicin is 5 mg/kg/dose @ 36 hourly interval. However we’ve seen actuate kidney injuries with this dosage and we’re wondering whether to change to cefotaxime instead. Would be grateful for your input.

[piatkat]

@RyoItoshima would you like to tell us about your practice from Japan?

[livia_sibiu@yahoo.com]

Penicillin and amikacyn

 

[Stefan Johansson]

We would also probably go with bensyl-Pc and Amikacin, the latter dosed every 48 hours (and with checking serum-konc of amikacin before the 2nd dose)

[varady]

On 4/6/2022 at 6:56 PM, dramitkan said:

Dear All, 

I wanted to know your unit’s antibiotic choice in 22-23 week babies. We use Benzyl Penicillin and Gentamicin. Dose of Gentamicin is 5 mg/kg/dose @ 36 hourly interval. However we’ve seen actuate kidney injuries with this dosage and we’re wondering whether to change to cefotaxime instead. Would be grateful for your input.

Empirical treatment of the first choice is Ampicilin/Gentamcin

[Vicky Payne]

Cefotaxime first line for EOS in Southampton. 

[Francesco Cardona]

We give Ampicillin / Gentamicin. Dose of Gentamicin is 5mg/kg first dose, then 36h later 3.5mg/kg @24h intervals. Step up from Ampicillin if there is evidence of other bacteria (resistant?) from mother

[NHowold]

Ampicillin/Gentamicin

Gentamicin 5 mg/kg every 48h hours according to the dosage handbook of the American pharmacists association 

[Jose Ramon Fernandez]

Ampicillin plus gentamicin in our NICU, according Neofax dosages. We stop antibiotics if blood culture is negative (48-72 hours) and no clinical or laboratory signs of active infection. 

[dramitkan]

On 4/12/2022 at 7:14 PM, Vicky Payne said:

Cefotaxime first line for EOS in Southampton. 

Hi Vicky

Do you use Cefotaxime monotherapy?

[Vicky Payne]

On 5/3/2022 at 2:56 PM, dramitkan said:

Hi Vicky

Do you use Cefotaxime monotherapy?

Yes- we would add in amoxicillin if concerns re: listeria. 

No aminoglycoside....

[Abdul kasim jaleel ahmed]

On 4/6/2022 at 8:26 PM, dramitkan said:

Dear All, 

I wanted to know your unit’s antibiotic choice in 22-23 week babies. We use Benzyl Penicillin and Gentamicin. Dose of Gentamicin is 5 mg/kg/dose @ 36 hourly interval. However we’ve seen actuate kidney injuries with this dosage and we’re wondering whether to change to cefotaxime instead. Would be grateful for your input.

We use Ampicillin and Amikacin 

kindly review your Gentamicin dosage in this clinical context can you please high light acute kidney injury is it dose related Acute tubular necrosis? 
please update thank you 

[Dr Mohamed Ali]

On 5/4/2022 at 5:49 PM, Vicky Payne said:

Yes- we would add in amoxicillin if concerns re: listeria. 

No aminoglycoside....

Hi Vicky

That's interesting as it will save doing drug levels and medications errors as well.

My questions

- how long since you intoduced this  as 1st line for EOS

- what's the microbiology advice regarding resisitance as you know most of other units use cefotaxime and vanc as 3rd line Abx.

- What's your second and third line Abx policy .

Thanks again

[Bernhard Bungert]

Gentamycin / Ampicillin. Intervall and Dose acorrding to Neofax. Through Level measuring before second Dose (who determine also peak level?). No 3. Generation Cephalosporines because reported higher appearence of ESBL bacteria. 

[Vicky Payne]

I can’t tell you how long we’ve used cefotaxime for- but definitely 10 years.
 

You are best speaking to a colleague of mine for more details- if you want to message me your email address I can pass it on?  Microbiology data monitored and I assume no concerns with ESBLs!

second line fluclox and gent or vanc and gent if a central line present. 

[selja]

We use amp and gent. With gent doses of 4mg q 48 hours.

We haven't experienced any kidney failure.