The Disputed Champion: Ampicillin and Gentamicin for Febrile Young Infants

Greenhow, Tara L.; Cantey, Joseph B.

doi:10.1542/hpeds.2017-0101

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…52 Although resistance to third-generation cephalosporins was more common in children with complex chronic conditions, two-thirds of infants with a cephalosporin-resistant pathogen did not have a complex chronic condition. Therefore, our findings support the empiric use of ampicillin plus gentamicin for most infants with suspected bacteremia while awaiting bacterial culture results, particularly given the lower risk of toxicity with once daily dosing 49 and the association of third-generation cephalosporin use with development of resistant bacteria. 53 When a pathogen is identified, which frequently occurs within 24 hours, 23 the antimicrobial regimen can be adjusted to provide definitive therapy.…”

Section: Discussionsupporting

confidence: 69%

“…Ampicillin plus gentamicin has traditionally been used for the empiric treatment of IBI in young infants. 48 However, concerns about gentamicin toxicity, 49 sub-optimal therapy with gentamicin alone in the setting of an ampicillin-resistant pathogen (up to 35% of isolates in this population), 15,19,39,44 and the low prevalence of Listeria monocytogenes 14,50,51 have all contributed to the common use of third-generation cephalosporins as empiric antimicrobial therapy for young infants, particularly in the second month of life. 9 However, we found that 11% of isolates, including those from infants in the second month of life, were resistant to third-generation cephalosoporins.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

Woll

Neuman

Pruitt

et al. 2018

The Journal of Pediatrics

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For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

Woll

Neuman

Pruitt

et al. 2018

The Journal of Pediatrics

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“…Out of the commonly employed antibiotics regimen, the combination of ampicillin with gentamicin had the highest treatment success rate at 77%, surpassing the combination of cefazolin with gentamicin, which achieved a success rate of only 60%. Therefore, the combination of ampicillin and gentamicin could be recommended as a promising choice for antibiotics therapy in jaundiced infants with UTI, which aligns with current recommendation regarding antibiotics therapy for neonatal UTI and febrile young infant in general (25). However, clinician should also take into consideration local surveillance of pathogens and antibiotics susceptibility patterns when choosing appropriate initial antibiotics treatment.…”

Section: Discussionmentioning

confidence: 67%

Risk factors for urinary tract infection in infants with unexplained hyperbilirubinemia: a single center case-control study

Chen,

Hsu,

Yao

et al. 2024

Front. Pediatr.

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BackgroundUrinary tract infection (UTI) is a potential cause of neonatal jaundice. Nevertheless, there remains a lack of consensus regarding appropriate screening practices for UTI in infants with hyperbilirubinemia. This study aimed to analyze a group of jaundiced infants to assess the prevalence of UTI, explore potential risk factors, and examine the impact of UTI on the course and severity of neonatal jaundice.MethodsThis retrospective case-control study was conducted on 150 jaundiced infants (aged < 8 weeks) without a known etiology in the hyperbilirubinemia work-up. All subjects underwent phototherapy treatment and UTI screening by catheterization. They were then classified into UTI and non-UTI groups based on urine culture results, with a positive urine culture indicating the growth of ≥10,000 colony-forming units. The clinical characteristics and jaundice-related parameters of both groups were analyzed.ResultsAmong the 150 jaundiced patients, the prevalence of UTI was 29%. There was a significantly higher male predominance in the UTI group, and patients with UTI also had a significantly longer duration of hospitalization compared to those without UTI. Significant risk factors associated with UTI in jaundiced infants included male gender and a peak total bilirubin level higher than 18 mg/dl during hospitalization. The most common pathogens identified in urine culture were Escherichia coli (41.9%) and Enterococcus faecalis (30.2%).ConclusionIn cases of neonatal jaundice where the underlying cause is not evident, screening for UTI should be performed, particularly when associated risk factors or inadequate response to phototherapy is present.

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“…Greenhow and Cantey also concluded that for empiric use in most infants with suspected bacteremia, ampicillin plus gentamicin was an effective combination while awaiting results of bacterial culture. This combination has a lower risk of toxicity with once-daily dosing [24]. Pokhrel et al recommend a combination of piperacillin-tazobactam and ofloxacin as the first-line therapy and a combination of vancomycin and meropenem as the second-line empirical therapy in infants admitted with sepsis in a neonatal intensive care unit [25].…”

Section: Bacteriological and Antibiotic Profilementioning

confidence: 99%

Bacteriological and antibiotic profile of infection among infants in the post-neonatal period at a tertiary care hospital in South India

Thattil

Ajith

2021

JHR

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PurposeSevere bacterial infection is a major cause of neonatal morbidity and mortality worldwide. Geographical-based demographic laboratory and clinical data are required to get a conclusion about the bacterial infection and their antibiotic susceptibility for the empiric antibiotic treatment in infants who presented with suspected infection. This study was aimed to find the most prevalent bacterial infection and antibiotic sensitivity among infants in the post-neonatal period presented at a tertiary care centre in South India.Design/methodology/approachA cross-sectional study was designed among infants (29 days to 1 year old) presented with suspected infection in the paediatric department. Infants with positive culture report were analysed for the bacteriological and antibiotic profile from the medical records. Antibiotic sensitivity was determined for the isolated bacteria according to standard procedure and data statically analysed.FindingsTotal of 218 samples (138 male and 80 female) were analysed. Most of the samples (171/218, 78.4%) were throat swab (p = 0.0247). Only one sample was cerebrospinal fluid from case of meningitis. Sample from upper RTI was major (162/218, 74.3%) with male dominance followed by stool samples from cases of diarrhoea (22/218, 10.0%). Staphylococcus aureus was the major organism identified in 46/171 (26.9 %) throat swabs. The most sensitive antibiotic against bacteria isolated from throat swab and CSF was gentamicin and cloxacillin. Netilmicin and piperacillin plus tazobactam were the sensitive antibiotics against bacteria isolated from stool, ear secretion and urine samples.Research limitations/implicationsShort duration and small sample size representing the population was the major limitations of this study. Furthermore, a multicentre population based study is warranted to develop a protocol/policy/rational use of antibiotics in the clinical setting for the empiric therapy.Practical implicationsPracticing good hygiene in child care is the best way to prevent infection. Community-based awareness and education should be given to parents in order to follow good hygiene in child care regularly. Furthermore, avoid delay in seeking treatment and provide the medicine prescribed at the right time and in the right dose to limit the morbidity and bacterial resistance.Social implicationsDespite the empirical antibiotic treatment in subjects presented with infection in the post-neonatal period, awareness about the exclusive breastfeeding, maternal and neonatal immunizations and antibiotic prophylaxis in case of suspected infection are warranted to reduce the incidence of infection. Furthermore, keeping the baby's environment clean, keeping safe distance from people who are unwell or avoiding contact with infected people are major home-based activities to protect infants from common infectious diseases. Changing diaper at frequent intervals can reduce the UTI and washing child's and caregiver's hands frequently can prevent food bone and respiratory infections.Originality/valueUpper RTI was the prevalent bacterial infection followed by diarrhoea in infants in the post-neonatal period. Klebsiella pneumoniae was the common organism identified in the overall report followed by E. coli and S. aureus. Community-based awareness should be provided to follow good hygiene regularly in child care. Furthermore, avoid delay in seeking treatment and provide the medicine prescribed at the right time and in the right dose to limit the morbidity and bacterial resistance.

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The Disputed Champion: Ampicillin and Gentamicin for Febrile Young Infants

Cited by 6 publications

References 25 publications

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

Risk factors for urinary tract infection in infants with unexplained hyperbilirubinemia: a single center case-control study

Bacteriological and antibiotic profile of infection among infants in the post-neonatal period at a tertiary care hospital in South India

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