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Ceftazidime in the treatment of neonatal infection
Insights
Ceftazidime effectively treated neonatal sepsis in premature infants, with only one infection-related death. However, some neonates developed resistant organisms post-treatment.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal sepsis poses a significant threat to low birthweight premature infants.
- Ceftazidime is a third-generation cephalosporin antibiotic with broad-spectrum activity.
- Limited data exists on ceftazidime's efficacy and safety in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy and safety of ceftazidime in treating neonatal sepsis.
- To assess the pharmacokinetic profile of ceftazidime in premature neonates.
- To monitor for adverse events and the emergence of antibiotic resistance.
Main Methods:
- A study involving 42 low birthweight premature infants with suspected or confirmed infections.
- Administration of ceftazidime (25 mg/kg bd, iv or im) for varying durations (48 hours to 5+ days).
- Inclusion of bacteriological, radiological, and clinical assessments, alongside fecal sample analysis and pharmacokinetic measurements.
Main Results:
- Ceftazidime treatment was associated with a low rate of infection-attributable mortality (1 death).
- Emergence of ceftazidime-resistant organisms was observed in 12 neonates post-treatment.
- No significant alterations in liver function tests, renal function, or protein levels were noted.
- Pharmacokinetic data indicated a half-life of 7.4 hours and clearance increasing with postnatal age.
Conclusions:
- Ceftazidime demonstrates potential efficacy in treating neonatal sepsis in premature infants.
- The emergence of resistant organisms necessitates careful monitoring and consideration of treatment duration.
- Ceftazidime appears to have a generally favorable safety profile regarding key laboratory parameters.
Abstract:
The efficacy of ceftazidime in the treatment of neonatal sepsis was studied in 42 low birthweight premature babies. Forty-nine courses of ceftazidime (25 mg/kg bd, iv or im were administered. In 19 babies, treatment was stopped after 48 h, the remainder were treated for 5 days or more. Six neonates had bacteriological evidence of infection, one other was pyrexial and 29 had radiological evidence compatible with respiratory tract infection. Eight of the study population died. Only one death was attributed to infection which arose 3 days after completion of a 5-day course of ceftazidime. Two babies developed clinical signs of necrotizing enterocolitis (NEC). Clostridium difficile (7) and Cl. perfringens (2) were isolated from 34 post-treatment faecal samples but not from the two babies with NEC. No faecal sample contained Cl. difficile toxin. Post-treatment cultures from 12 neonates yielded ceftazidime-resistant micro-organisms. Ceftazidime therapy was not associated with significant alteration in serum alanine aminotransferase, urea, creatinine, protein or albumin. Four babies had an eosinophilia, three transient and one following two intrauterine transfusions. Coombs' tests were performed on 17 babies. There were no false positives. The abnormal clotting studies observed in one baby were not due to ceftazidime. In a concurrent pharmacokinetic study, the half-life of ceftazidime was 7.4 (SD +/- 4.1) h following iv administration. Other pharmacokinetic values were C max 74 (SD +/- 20) mg l-1 trough concentration 20 (SD +/- 10) mg l-1. Total body clearance ranged from 0.13 to 2.10 ml min-1 per kg and increased with increasing postnatal age.(ABSTRACT TRUNCATED AT 250 WORDS)