title: Serum concentrations of amoxicillin in neonates during continuous intravenous infusion.
abstract: Amoxicillin is commonly used for the treatment of neonatal bacterial infection with intermittent dosing (ID) regimens. However, increasing bacterial resistance, in addition to a lack of new antimicrobial agents, urges the optimization of current therapeutic options. Clinical studies in adults suggest continuous infusion (CI) regimens of beta-lactam antibiotics to be superior to ID. There are as yet no guidelines concerning the CI dosing of amoxicillin. The present study was developed to describe the CI pharmacokinetics and -dynamics of amoxicillin during the first 3 days of life in search of the optimal dosing regimen. Neonates with a gestational age above 34 weeks, at risk of neonatal infection and requiring amoxicillin therapy, were included. Serum concentrations of amoxicillin were measured during CI on days 1 and 3 in the steady state. Twenty-two serum samples of 11 patients were collected. All patients reached and retained serum concentrations of amoxicillin within the therapeutic range without exceeding the toxic concentration (serum concentrations on day 1 mean 55.4 mg/l, range 30.9-69.5, SD 10.5, and on day 3 48.8 mg/l, range 25.5-92.4, SD 18.4). There was no significant decrease in concentration from day 1 to day 3 (p = 0.38). This study showed therapeutic, nontoxic concentrations of amoxicillin in neonates on CI of amoxicillin in the first 3 days of life. Randomized controlled trials should reveal whether the clinical benefits of the CI of amoxicillin exceed those of ID regimens.
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Boekholt
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Fleuren
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Mouton
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Kramers
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Sprong
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Gerrits
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands. b.semmekrot@cwz.nl.
authors.forename: B
authors.initials: B
authors.lastname: Semmekrot
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D015415:Biomarkers; D001830:Body Surface Area; D001835:Body Weight; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D007262:Infusions, Intravenous; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D000658:Amoxicillin