Related Experiment Videos
Piperacillin in early neonatal infection
Insights
Piperacillin and flucloxacillin effectively treated early bacterial infections in newborns. While generally safe, critically ill infants with neutropenia or meningitis may require a second antibiotic due to potential E. coli resistance.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal bacterial infections pose a significant threat in the first 48 hours of life.
- Effective antibiotic regimens are crucial for combating early-onset sepsis in neonates.
Purpose of the Study:
- To evaluate the efficacy and safety of piperacillin and flucloxacillin versus penicillin and gentamicin for treating suspected bacterial infections in neonates.
- To assess piperacillin pharmacokinetics, including serum and cerebrospinal fluid concentrations and half-life, in neonates.
Main Methods:
- A comparative study involving 70 neonates with suspected bacterial infection.
- Treatment groups received either piperacillin/flucloxacillin or penicillin/gentamicin.
- Pharmacokinetic parameters of piperacillin were measured, including serum and CSF levels and half-life.
Main Results:
- Piperacillin and flucloxacillin successfully eradicated confirmed infections in 6 out of 35 infants.
- Penicillin and gentamicin treated 4 infants with confirmed infections; one initially deteriorated but recovered with piperacillin.
- Therapeutic piperacillin concentrations were achieved in serum and CSF, with a median half-life of 6.5 hours, prolonged in renal impairment.
Conclusions:
- Piperacillin is a safe and effective first-line treatment for early neonatal infections.
- Combination therapy may be necessary for critically ill neonates with neutropenia or meningitis due to potential resistance in some Escherichia coli strains.
Abstract:
Seventy infants with suspected bacterial infection in the first 48 hours of life were treated either with piperacillin and flucloxacillin or with penicillin and gentamicin. Infection was confirmed and successfully eradicated in 6 of the 35 infants receiving piperacillin and flucloxacillin. Four infants treated with penicillin and gentamicin had confirmed infection and one deteriorated initially but then recovered when treated with piperacillin. Serum piperacillin concentrations above 100 mg/l and cerebrospinal fluid piperacillin concentrations of 2.6-6 mg/l were noted for up to four hours and 7 hours respectively, even in the absence of inflamed meninges, after administration of piperacillin 100 mg/kg body weight intravenously. Median half life of piperacillin was 6.5 hours and was prolonged in renal impairment. Piperacillin is considered to be a safe and effective first line single agent treatment for early neonatal infection but because some Escherichia coli are resistant to it we recommend that a second agent be used in critically ill infants with neutropenia or meningitis.