Intravenous rifampicin in neonates with persistent staphylococcal bacteraemia

Abstract

Addition of intravenous rifampin is reported to be useful in prompt clearance of persistent coagulase negative staphylococcal (CONS) bacteraemia in high‐risk neonates. Four neonates (mean birthweight 823 g, mean gestation 25 wk) with persistent CONS bacteraemia for < 7–10 d (mean 11) were treated with i.v. rifampicin (10mg/kg/12 h ± 10 d) while continuing vancomycin (15mg/kg/24 h). Their age at time of infection ranged from 2 to lid. The mean (range) vancomycin peak and trough concentrations were 29 (25–35) and 6 (4–10) μg/ml, respectively. The blood isolates were Staphylococcus epidermidis, S. hominis, and S. haemolyticus. Addition of rifampicin was associated with prompt clearance of bacteraemia within 48 h (n= 3) and 5 d (n– 1). Rifampicin‐related adverse effects such as abnormal liver function tests and thrombocytopenia did not occur. Conclusion: Addition of i.v. rifampicin to vancomycin may optimize the outcome of persistent CONS bacteraemia and the risk of bacterial resistance related to prolonged exposure to vancomycin.

Intravenous rifampicin for persistent staphylococcal bacteremia in premature infants

“…All the neonates tolerated rifampicin therapy without any significant adverse effects, such as liver function tests, rash, thrombocytopenia or elevated blood urea nitrogen. The present clinical observations of prompt clearance of persistent CoNS bacteremia after addition of rifampicin to vancomycin are similar to those reported previously 3,4 . Both the infants were symptomatic and presence of bacteremia on three different blood cultures with similar antimicrobial susceptibility patterns indicates that this was a true infection, not a contaminant.…”

“…Persistent CoNS bacteremia was defined as three or more consecutive positive blood cultures, at least 48 h apart, during a single sepsis episode 6 . Rifampicin has been used successfully as an adjunct in the treatment of persistent staphylococcal sepsis in neonates 3,4 . In the two published case reports (total 14 neonates), the mean gestational age was 27.6 weeks (range 23–32 weeks) and mean birthweight was 878 g (range 550–1377 g).…”

“…6 Rifampicin has been used successfully as an adjunct in the treatment of persistent staphylococcal sepsis in neonates. 3,4 In the two published case reports (total 14 neonates), the mean gestational age was 27.6 weeks (range 23 -32 weeks) and mean birthweight was 878 g (range 550 -1377 g). Age at the time of infection ranged from 6 to 72 days (mean, 21 days).…”

“…The addition of rifampicin to vancomycin has been reported to be useful in prompt clearance of CoNS bacteremia in high-risk neonates. 3,4 We report clinical observations in two extremely low-birthweight neonates with persistent staphylococcal bacteremia, who responded with prompt clearance of bacteremia after addition of rifampicin to vancomycin.…”

Management of antibiotic-resistant infection in the newborn

“…For more invasive staphylococcal infections, addition of rifampin to vancomycin may be useful: this approach has been reported to successfully clear (usually within 48 h) persistent CoNS bacteraemia 9. Rifampicin penetrates CSF well, and is often combined with vancomycin for treatment of patients with meningitis with MRSA or with cefotaxime and vancomycin for penicillin-resistant pneumococci.…”