Bernhard Csillag Posted February 10 Share Posted February 10 Hello everyone! In Austria we are facing an Ampicillin Shortage - I suppose this will be the same in whole Europe. As iv Amoxicillin is not common available, too, the question about the best alternative arises. Any thoughts on good alternatives to pair with an amonoglycoside? Or another combination? A possible empiric therapy would be Pip/Taz, but that would be too broad already, right? Would a combination of Flucloxacillin with Gentamicin or Tobramycin be enough? thank you for your thoughts! best wishes bernhard 1 Link to comment Share on other sites More sharing options...
Stefan Johansson Posted February 11 Share Posted February 11 Hello! Our baseline regimen for suspected early onset sepsis is bensyl-Pc + aminoglycoside. But I suppose one need to take local resistance patterns into account. But aren't gr-B streps (that we want to cover well in early Tx) like "always" sensitive to bensyl-PC. We do use ampi in suspected meningitis Tx, but I have not heard about any shortage (yet) 3 Link to comment Share on other sites More sharing options...
99nicu.org Posted February 11 Share Posted February 11 2 Link to comment Share on other sites More sharing options...
Padkaer Posted February 11 Share Posted February 11 In DK first 3 days penicillin + genta. After that PipTaz for NICU patients. Rational for ampicillin was primarily listeria, which is exceedingly rare today in DK (and in most cases penicillin sensitive). A cefalosporin like cefuroxim would also give coverage for the majority of the usual suspects within neonatology (GBS, Staph A, E Coli), but offers no protection against Listeria. You can see the Danish guide with doses here. It's in Danish, but doses etc should be intelligible. Let me know if you have questions https://www.paediatri.dk/images/dokumenter/Retningslinjer_2021/sepsis_og_meningitis_rev._23.05.21.pdf 3 Link to comment Share on other sites More sharing options...
Bernhard Csillag Posted February 11 Author Share Posted February 11 Thank you for your answers. pen/Tob sounds like a good way to start and P/T for LOS sound very reasonable, too. Cochrane tried to look into this topic without a result. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127574/ Thank you! 2 Link to comment Share on other sites More sharing options...
Stefan Johansson Posted February 12 Share Posted February 12 @Bernhard Csillag Another ”more research is needed” report… Link to comment Share on other sites More sharing options...
Stefan Johansson Posted February 24 Share Posted February 24 Found this on Tw! Link to comment Share on other sites More sharing options...
Bernhard Csillag Posted Monday at 09:13 PM Author Share Posted Monday at 09:13 PM On 2/11/2023 at 10:31 AM, Stefan Johansson said: Hello! Our baseline regimen for suspected early onset sepsis is bensyl-Pc + aminoglycoside. But I suppose one need to take local resistance patterns into account. But aren't gr-B streps (that we want to cover well in early Tx) like "always" sensitive to bensyl-PC. We do use ampi in suspected meningitis Tx, but I have not heard about any shortage (yet) What dosage do you use with PenG? 25.000 or 50.000 per kg per dose. (Frequency depending on PMA)? thank you! Link to comment Share on other sites More sharing options...
Stefan Johansson Posted Tuesday at 09:07 AM Share Posted Tuesday at 09:07 AM @Bernhard Csillag I cut and paste from our regional pharmacopedia, we dose PenG depending on gestational age at birth and postnatal age as below. Depending on symtom severity we give 50 or 100 mg/kg/dose, the most usual dose being 50 mg/kg/dose Quote Postnatal age 0 - 7 days: Gestational age <33 weeks: 50 - 100 mg/kg x 2 Gestational age ≥33 weeks: 50 - 100 mg/kg x 3 Postnatal age 8 - 28 dagar: Gestational age <33 weeks: 50 - 100 mg/kg x 3 Gestational age ≥33 weeks:: 50 - 100 mg/kg x 4 Link to comment Share on other sites More sharing options...
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