Combination drugs and acute kidney injury (AKI): Prospective trials in adults suggest Piperacillin-tazobactam does not cause kidney injury when given as a single agent. (14) Adult meta-analysis using retrospective data suggested that piperacillin-tazobactam and vancomycin combination was associated with AKI, (10) but this remains controversial and further study is required. (9) A recent neonatal multicentre retrospective study evaluating the incidence of AKI found decreased risk of AKI with vacomycin and piperacillin-tazobactam combination, relative to gentamicin + indomethacin. (11)
Safety
Study by Berger et al found no clinical adverse events in VLBW infants, in particular, no cases of
phlebitis, rash or stool changes. No long-lasting effect on the intestinal flora was detected. Several mild and transitory laboratory abnormalities including elevated direct bilirubin and other liver enzymes, thrombocytosis and elevated eosinophilic count were noted but none of them required discontinuation of antibiotic therapy.(13)
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