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Updated: Jun 20, 2026
Probiotic Studies in Neonatal Mice Using Gavage
Published on: January 27, 2019
Antibiotics for the newborn
Gaetano Chirico1, Fabiana Barbieri, Claudia Chirico
1Department of Neonatology and Neonatal Intensive Care, Spedali Civili, Brescia, Italy. gaechirico@alice.it
Insights
Antibiotic use in newborns requires careful consideration of their unique physiology and organ immaturity. Dosing and duration must be adjusted based on pharmacokinetic data for optimal safety and efficacy in neonates.
Area of Science:
- Neonatal pharmacology
- Pediatric infectious diseases
- Clinical pharmacy
Background:
- Neonates have high susceptibility to infections, making antibiotics a common treatment.
- Neonatal physiology, including immature kidney and liver function, significantly impacts antibiotic efficacy and safety.
- Factors like gestational age, birth weight, and intrauterine growth restriction influence drug pharmacokinetics in newborns.
Purpose of the Study:
- To review the key considerations for antibiotic therapy in neonates.
- To highlight the importance of pharmacokinetic and pharmacodynamic parameters in neonatal antibiotic dosing.
- To discuss current recommendations for antibiotic use and emerging applications in neonatal care.
Main Methods:
- Review of existing literature on neonatal antibiotic pharmacokinetics and pharmacodynamics.
- Analysis of current clinical practices and guidelines for antibiotic use in newborns.
- Examination of recent studies on novel applications of antibiotics in neonatal medicine.
Main Results:
- Antibiotic dosing, timing, and administration routes must account for neonatal variability in absorption, distribution, metabolism, and excretion.
- Ampicillin and gentamicin remain a standard initial empiric therapy for suspected neonatal sepsis.
- Other antibiotics like cephalosporins, carbapenems, and glycopeptides require judicious use to maximize efficacy and minimize toxicity.
- Macrolides, such as erythromycin and azithromycin, show promise for non-antibacterial indications like gastrointestinal dysmotility and prevention of bronchopulmonary dysplasia.
Conclusions:
- Optimizing antibiotic therapy in neonates necessitates a personalized approach based on individual physiological characteristics and pharmacokinetic data.
- Careful selection and judicious use of antibiotics are crucial for managing infections and preventing adverse outcomes in newborns.
- Emerging evidence suggests potential benefits of macrolides beyond their antibacterial properties in specific neonatal conditions.
Abstract:
Because of the high susceptibility to infections, antibiotics are the most widely used drugs in newborns. The result of antibiotic use, however, may be strongly influenced by the peculiar physiology of the neonate, characterized by the delicate process of adaptation from intra- to extra-uterine life. Additional important factors that may affect antibiotic therapy are gestational age, birth weight, the intrauterine growth restriction, chronological age and, especially, the kidney and liver function immaturity. Dosing, timing and route of administration must, therefore, take in careful consideration the neonatal variability of bioavailability, distribution, metabolism, biotransformation, and excretion. The fine adjustment of dosing and duration of therapy should be based on pharmacokinetic and pharmacodynamic parameters. In spite of significant variations of sepsis etiology, the best initial empiric therapy of a suspected systemic infection still remains, as several years ago, the association of ampicillin and gentamicin. Other very effective and useful antibiotics, as cephalosporins, carbanepems or glycopeptides should be administered judiciously to infants, following the recommendations of a restricted use, to obtain maximal efficacy and minimal toxicity. Finally, because of their peculiar features, macrolide antibiotics have recently been proposed for different indications than the antibacterial activity. Use of oral erythromycin for the treatment of gastrointestinal dysmotility in preterm infants could reduce the incidence of parenteral nutrition-associated cholestasis by almost 50%, while azithromycin because of the combined antibiotic and anti-inflammatory effects, has been successfully used in a pilot study in the extremely low birth weight infant for the prevention of bronchopulmonary dysplasia.
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