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Oral pivampicillin and amoxycillin in newborn infants
Insights
Amoxycillin and pivampicillin offer effective oral antibiotic options for newborns. These drugs, when given orally, achieve significant plasma levels comparable to intramuscular ampicillin, suggesting utility in treating neonatal infections.
Area of Science:
- Pharmacology
- Neonatal Medicine
- Infectious Diseases
Background:
- Neonatal infections require effective antibiotic treatment.
- Oral antibiotic administration is preferred when feasible for safety and ease.
- Understanding the pharmacokinetics of oral antibiotics in neonates is crucial.
Purpose of the Study:
- To compare the pharmacokinetic profiles of oral amoxycillin and pivampicillin against intramuscular ampicillin in fasting newborn infants.
- To evaluate the suitability of amoxycillin and pivampicillin for oral therapy in neonates.
Main Methods:
- A cross-over trial involving 14 fasting newborn infants (6-13 days old).
- Administration of ampicillin intramuscularly, and amoxycillin or pivampicillin orally at 50 mg/kg twice daily.
- Measurement of peak plasma levels and area under the time-concentration curve (AUC) for each antibiotic.
Main Results:
- Oral amoxycillin and pivampicillin achieved mean peak plasma levels of 58% and 48%, respectively, compared to intramuscular ampicillin.
- The AUC for amoxycillin was 75% of intramuscular ampicillin, while pivampicillin's AUC was 51% (p < 0.05).
- Amoxycillin demonstrated a more favorable pharmacokinetic profile than pivampicillin in this neonatal cohort.
Conclusions:
- Both amoxycillin and pivampicillin show potential for oral treatment of neonatal infections caused by susceptible microorganisms.
- Amoxycillin appears particularly promising due to its pharmacokinetic profile in non-critically ill neonates.
- Further studies may be warranted to establish optimal dosing and efficacy in diverse neonatal populations.
Abstract:
Ampicillin was administered intramuscularly and amoxycillin or pivampicillin orally to 14 fasting newborn infants, 6-13 days old, in a cross-over trial. The dose was 50 mg/kg twice daily. The mean peak plasma level of amoxycillin and pivampicillin was 58% (range 35-96%) and 48% (33-82%) of that noted after i.m. ampicillin, which gave a value of about 44 +/- 5 micrograms/ml (mean +/- SEM) in both groups. The area under the time-concentration curve was 75% (range 60-101%) of that of i.m. ampicillin for amoxycillin and 51% (20-76%) for pivampicillin (p less than 0.05). Both drugs, especially amoxycillin, should be useful for oral treatment of neonatal infections caused by susceptible microorganisms in infants who are not critically ill.