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Pediatr Int. 2011 Dec;53(6):873-80. doi: 10.1111/j.1442-200X.2011.03468.x.

Ampicillin versus penicillin in the empiric therapy of extremely low-birthweight neonates at risk of early onset sepsis.

Author information

1
Pediatric Intensive Care, Tallinn Children's Hospital, Tallinn, Estonia. tuuli.metsvaht@kliinikum.ee

Abstract

BACKGROUND:

There are no comparative data on the impact of different empiric antibiotic regimens on early bowel colonization as well as on clinical efficacy in extremely low-birthweight (ELBW) neonates at risk of early onset sepsis (EOS).

METHODS:

A subgroup analysis was carried out of ELBW neonates recruited into a two-center, prospective, cluster randomized study comparing ampicillin and penicillin both combined with gentamicin, within the first 72 h of life. A composite primary end-point (need for change of antibiotics within 72 h and/or 7 day all-cause mortality) and the rate and duration of colonization by opportunistic aerobic microorganisms were assessed using hierarchical models corrected for study center and period.

RESULTS:

In the ampicillin (n= 36) and penicillin (n= 39) groups change of antibiotics, 7 day mortality and the composite end-point occurred at similar rates. Neonatal intensive care unit mortality for infants with gestational age <26 weeks was lower in the ampicillin group. Ampicillin treatment was associated with a higher colonization rate by Klebsiella pneumoniae, including ampicillin-resistant strains.

CONCLUSION:

Preliminary data indicate an urgent need for adequately powered studies of early antibiotic therapy in the subpopulation of ELBW neonates at risk of EOS.

[Indexed for MEDLINE]

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