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Neonatal Intensive Care Drug Manual
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| bet | 56/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Evidence summary
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Amoxicillin-clavulanate shows good activity against organisms associated with acute otitis media and, community acquired pneumonia in childhood including penicillin-susceptible and -intermediate strains, of Streptococcus pneumoniae, and β-lactamase producing strains of Haemophilus influenzae and, Moraxella catarrhalis. A high-dose formulation has been developed with the aim of providing better, coverage for penicillin-resistant strains. [7] Gram-negative organisms require higher and more, sustained levels of both amoxicillin and clavulanic-acid for optimal therapy. For clinical syndromes in, which Gram-negative pathogens are causative (e.g. urinary tract infection), a narrower ratio (e.g. 4:1), with more frequent dosing (three or four rather than two times daily) is needed for efficacy. [8] Oral antibiotics for neonatal infections: A systematic review of studies that assessed oral versus, parenteral antibiotics and switching to oral therapy from parenteral antibiotics in newborns included, 31 studies. Oral antibiotics reached maximum concentrations later and had lower bioavailability, but in, the majority of cases, adequate serum levels for bacterial killing were reached. Furthermore, studies, on efficacy of oral antibiotics showed similar relapse rates (OR 0.95; 95% CI 0.79–1.16; I2 0%) and, mortality (OR 1.11; 95% CI 0.72–1.72; I2 0%), and a reduction in hospital stay. Although early switch to, oral antibiotics after a short course of IV antibiotics is promising in term neonates with a (probable), bacterial infection, the lack of large well-designed studies in a high-income setting requires further, trials to establish the safety and efficacy of iv-to-oral switch therapy in neonates. [9] [LOE I GOR C]
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