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Neonatal Intensive Care Drug Manual
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| bet | 479/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Special comments
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Doses here are expressed as the piperacillin component.
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Evidence
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Efficacy
A prospective, open-label non-comparative trial by Berger et al in 27 very low birthweight (VLBW) infants ≤1500 g with nosocomial sepsis, necrotising enterocolitis, intra-abdominal infections found that piperacillin-tazobactam is safe and well tolerated with no adverse events considered related to the drug. Clinical efficacy evaluation revealed cure or improvement in 17 patients (63%). Of the 10 patients with unfavorable clinical response, two had growth of pathogens resistant to piperacillin-tazobactam in the blood culture (one with oxacillin resistant Staphylococcus epidermidis and the other with Candida albicans). In one patient with NEC and perforation, surgical treatment was withheld due to the extremely low birth weight and poor general condition of this patient, resulting in death 3 days after beginning of piperacillin/tazobactam treatment. (13)
Dose schedule: Prospective multicenter non-comparative trial by Cohen-Wolkowiez et al in preterm and term infants of <61 days with suspected systemic infection suggested a Postmenstrual age (PMA)-based dosing (100 mg/kg q 8 h, 80 mg/kg q 6 h, and 80 mg/kg q 4 h for PMA of<30, 30 to 35, and 35 to 49 weeks, respectively), to achieve therapeutic target of time above the MIC (≤32mg/liter) for 75% of the dosing interval in 90% of infants. This study also suggested no advantages of prolonged (2−4 hour) infusion over short (over 30 minutes) infusion.(3) While the study recommends 4 hourly dosing for 35−49 weeks gestation, prolonging the interval to 6 hours in this group was also suggested as reasonable particularly for culture negative sepsis as 6-hour regime still attains the target rate in 80% of this group. (3, 4)
ECMO: A case-control study in adults showed that volume of distribution and clearance was similar compared to non-ECMO patients, but only 40% of adults on ECMO achieved the target exposure for treatment of Pseudomonas aeruginosa when receiving a dose of 4 g every 6 hours. (5, 6) Based on these results, while standard dosing may be adequate for susceptible organisms, an alternate antibiotic such as meropenem has been suggested for serious infections in patients on ECMO.
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