Monotherapy with Amikacin or Piperacillin-Tazobactum Empirically in Neonates at Risk for Early-Onset Sepsis: A Randomized Controlled Trial

Abstract

Monotherapy with amikacin as an empirical antibiotic did not result in a higher incidence of treatment failure in neonates at risk for early-onset sepsis as compared with piperacillin-tazobactum. Both antibiotics were effective in management of babies with early-onset sepsis.

A Review of Antibiotic Used in Suspected Early-Onset Neonatal Sepsis From Malaysian Perspective: Which Ones to Choose and How Long to Give?

“…The longest treatment duration for suspected EOS reported in this compilation was ≥7 days [3] and the shortest was 3 days or less [3,57]. Two studies did not mention clearly the treatment duration used in their study [26,54].…”

“…All articles were published between the year 2003 and 2016 with three RCTs, two prospective, and six retrospective studies. The largest sample population was 128,914 babies reported in a retrospective study by Clark et al [25] and the smallest sample population was 59 babies reported in a RCT study by Tewari and Jain [54].…”

“…Four studies compared two different treatment combinations (ampicillin plus gentamicin vs. piperacillin-tazobactam; ampicillin plus gentamicin versus C-penicillin plus gentamicin; ampicillin plus cefotaxime versus ampicillin plus gentamicin; and ampicillin plus aminoglycosides versus C-penicillin plus aminoglycosides) [21,25,26,55]. One study compared two different monotherapies (amikacin vs. piperacillin-tazobactam) [54].…”

“…Prolonged postnatal exposure to an empiric antibiotic is a risk factor for developing necrotizing enterocolitis (NEC) [57,61]. Piperacillintazobactam showed less NEC and diaper rash effect as compared to ampicillin plus gentamicin [55] and similar efficacy with amikacin monotherapy [54] in neonates at risk of EOS.…”

“…From the review, we found that first-line empiric antibiotic regime suggested in the guidelines (ampicillin plus gentamicin or penicillin plus gentamicin) seems to be favorable with similar effectiveness. Piperacillin-tazobactam has the potential to be an alternative treatment in the management of suspected early-onset neonatal sepsis [54,55]. The use of cefotaxime antibiotic, however, should be limited due to undesirable outcome [62].…”