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

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)

 

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

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!

@Bernhard Csillag Another ”more research is needed” report…

Found this on Tw!

 

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!

@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

 

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I use Ampicillin and Gentamycin