title: Ampicillin versus penicillin in the empiric therapy of extremely low-birthweight neonates at risk of early onset sepsis.
abstract: BACKGROUND
  There are no comparative data on the impact of different empiric antibiotic regimens on early bowel colonization as well as on clinical efficacy in extremely low-birthweight (ELBW) neonates at risk of early onset sepsis (EOS).
  
  
  METHODS
  A subgroup analysis was carried out of ELBW neonates recruited into a two-center, prospective, cluster randomized study comparing ampicillin and penicillin both combined with gentamicin, within the first 72 h of life. A composite primary end-point (need for change of antibiotics within 72 h and/or 7 day all-cause mortality) and the rate and duration of colonization by opportunistic aerobic microorganisms were assessed using hierarchical models corrected for study center and period.
  
  
  RESULTS
  In the ampicillin (n= 36) and penicillin (n= 39) groups change of antibiotics, 7 day mortality and the composite end-point occurred at similar rates. Neonatal intensive care unit mortality for infants with gestational age <26 weeks was lower in the ampicillin group. Ampicillin treatment was associated with a higher colonization rate by Klebsiella pneumoniae, including ampicillin-resistant strains.
  
  
  CONCLUSIONS
  Preliminary data indicate an urgent need for adequately powered studies of early antibiotic therapy in the subpopulation of ELBW neonates at risk of EOS.
authors: Pediatric Intensive Care, Tallinn Children's Hospital, Tallinn, Estonia. tuuli.metsvaht@kliinikum.ee
authors: Tuuli
authors: T
authors: Metsvaht
authors: Mari-Liis
authors: ML
authors: Ilmoja
authors: Ulle
authors: U
authors: Parm
authors: Mirjam
authors: M
authors: Merila
authors: Lea
authors: L
authors: Maipuu
authors: Piia
authors: P
authors: Müürsepp
authors: Kadri
authors: K
authors: Julge
authors: Epp
authors: E
authors: Sepp
authors: Irja
authors: I
authors: Lutsar
mesh_terms: D017668:Age of Onset; D000667:Ampicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007226:Infant Mortality / Q000639:trends; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007422:Intestines / Q000382:microbiology; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D010406:Penicillins / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin