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[Experiences with ceftazidime in the therapy of neonatal infections]
1Department of Bacteriology, Queen Charlotte's Maternity Hospital, London, England.
Insights
Ceftazidime shows favorable clinical responses and superior pharmacokinetics compared to gentamicin and ampicillin in neonates. This antibiotic demonstrated no significant side effects or increased resistance, making it a safe and effective neonatal treatment.
Area of Science:
- Neonatal pharmacology
- Infectious disease treatment
- Antibiotic efficacy
Context:
- Evaluation of ceftazidime's safety and efficacy in neonatal care over three years.
- Comparison with traditional antibiotics like gentamicin and ampicillin.
- Assessment of potential impacts on neonatal physiology and microbial resistance patterns.
Purpose:
- To assess the clinical effectiveness of ceftazidime as monotherapy in neonates.
- To evaluate the pharmacokinetic profile and safety of ceftazidime in this population.
- To monitor for adverse effects, including haematological, biochemical, and clotting disturbances, as well as changes in microbial colonization and resistance.
Summary:
- Ceftazidime monotherapy demonstrated clinical responses comparable to gentamicin and ampicillin, with superior pharmacokinetics and activity.
- No significant haematological, biochemical, or neonatal blood clotting side effects were observed.
- Neonatal colonization with faecal streptococci increased with third-generation cephalosporins but caused no clinical issues; no increase in Enterobacter spp. or ceftazidime-resistant organisms was noted.
- Ceftazidime does not accumulate in neonates at 25 mg/kg 12 hourly, maintaining a superior serum therapeutic ratio against common neonatal pathogens compared to gentamicin with penicillin or ampicillin.
Impact:
- Ceftazidime offers a safe and effective therapeutic option for neonatal infections, with a favorable side effect profile and strong antimicrobial activity.
- The findings support the use of ceftazidime in neonatal settings, highlighting its advantages over older antibiotic regimens.
- This study contributes to evidence-based guidelines for neonatal antibiotic stewardship, emphasizing the importance of pharmacokinetic considerations and resistance monitoring.
Abstract:
Our experience of ceftazidime during the last three years has in almost every respect been favourable. As monotherapy it has resulted in clinical responses at least as good as those from gentamicin and ampicillin. The pharmacokinetics and activity of ceftazidime are far superior to those of gentamicin. We have not been able to demonstrate any significant haematological or biochemical side effects of ceftazidime therapy nor does it adversely affect neonatal blood clotting mechanisms. The incidence of superficial candidosis has not changed during the last three years. Use of third generation cephalosporins has resulted in an increase in neonatal colonisation with faecal streptococci but this has not resulted in any clinical problems. We have not observed any increase in the number of isolates of Enterobacter spp. nor has there been an increase in the number of ceftazidime resistant microorganisms including Clostridium difficile, since ceftazidime was introduced. Drug accumulation does not occur in neonates receiving 25 mg/kg 12 hourly and throughout the dosage interval the serum therapeutic ratio for ceftazidime against common neonatal pathogens is superior to that of gentamicin with penicillin or ampicillin.