Observations on oral Sultamicillin/Unasyn CP-45 899 therapy of neonatal infections

The use of an effective antimicrobial remains a problem in the neonate, thereby necessitating empiric combinations of parenteral agents. We therefore studied oral Sultamicillin's (Unasyn CP-45 899) efficacy and tolerability (dose = 50 mg/kg per day) in the treatment of serious infections in 27 neonates over an 18 month period. The study cohort comprised newborns with suspected or confirmed infections in the Special Care Baby Unit of a referral hospital. The infants with overwhelming/severe infections or proven/suspected renal, hepatic or hematologic disease; or known hypersensitivity to penicillins or any beta-lactams were excluded. There were 12 babies with skin and soft-tissue infections, although pneumonia [11] was most predominant in our series. Bacterial isolates were mainly Staphylococcus aureus, Escherichia Coli and Klebsiella pneumoniae with a beta-lactamase production rate of 88%. The clinical cure and improvement rates were 96.3 and 100%, respectively and the evaluable bacteriologic cure-rate was 93.8%. The mean (S.D.) duration of therapy was 7.4 (2.6) days (range, 4-14) with significant resolution of features occurring within a 48 h period (24 27 , P < 0.01). No serious adverse/side effects were seen as only one (3.7%) experienced mild loose stools. We show with these prospective observations (our cohort albeit small) that sultamicillin orally is efficacious, tolerable and safe for treating of mild to moderate infections in the newborn caused by both gram-positive and gram-negative pathogens.