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Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship
OBJECTIVE: Define optimal ampicillin dosing for empiric early-onset sepsis (EOS) therapy in preterm neonates. STUDY DESIGN: We simulated ampicillin concentrations in newborns (birthweight<1500g; gestational age 22–27 weeks), summarizing three 48-hour regimens: high 100mg/kg Q8hr, medium 100mg/kg...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262754/ https://www.ncbi.nlm.nih.gov/pubmed/35210541 http://dx.doi.org/10.1038/s41372-022-01344-2 |
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author | Le, Jennifer Greenberg, Rachel G. Yoo, YoungJun Clark, Reese H. Benjamin, Daniel K. Zimmerman, Kanecia O. Cohen-Wolkowiez, Michael Wade, Kelly C. |
author_facet | Le, Jennifer Greenberg, Rachel G. Yoo, YoungJun Clark, Reese H. Benjamin, Daniel K. Zimmerman, Kanecia O. Cohen-Wolkowiez, Michael Wade, Kelly C. |
author_sort | Le, Jennifer |
collection | PubMed |
description | OBJECTIVE: Define optimal ampicillin dosing for empiric early-onset sepsis (EOS) therapy in preterm neonates. STUDY DESIGN: We simulated ampicillin concentrations in newborns (birthweight<1500g; gestational age 22–27 weeks), summarizing three 48-hour regimens: high 100mg/kg Q8hr, medium 100mg/kg Q12hr, and standard 50mg/kg Q12hr. Concentration data were analyzed for concentration above minimum inhibitory concentration (MIC), below neurotoxicity threshold (C(max)≤140mcg/mL), and duration limited to 48 hours. RESULTS: Among 34,689 newborns, all dosing regimens provided concentrations above MIC through 48 hours, but C(max) exceeded the neurotoxicity threshold. With the 4-dose standard regimen, >90% maintained concentrations >MIC beyond 48 hours. With the 2-dose regimen, newborns maintained the mean concentration >MIC within the 48-hour culture window and below neurotoxicity level. Infants 22–24 weeks’ gestation had higher drug concentrations and more prolonged exposure duration than 25–27 weeks’ gestation. CONCLUSIONS: For EOS in preterm infants, two ampicillin doses (50mg/kg) provided optimal bactericidal exposures, while minimizing potential toxicity. |
format | Online Article Text |
id | pubmed-9262754 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
record_format | MEDLINE/PubMed |
spelling | pubmed-92627542022-08-24 Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship Le, Jennifer Greenberg, Rachel G. Yoo, YoungJun Clark, Reese H. Benjamin, Daniel K. Zimmerman, Kanecia O. Cohen-Wolkowiez, Michael Wade, Kelly C. J Perinatol Article OBJECTIVE: Define optimal ampicillin dosing for empiric early-onset sepsis (EOS) therapy in preterm neonates. STUDY DESIGN: We simulated ampicillin concentrations in newborns (birthweight<1500g; gestational age 22–27 weeks), summarizing three 48-hour regimens: high 100mg/kg Q8hr, medium 100mg/kg Q12hr, and standard 50mg/kg Q12hr. Concentration data were analyzed for concentration above minimum inhibitory concentration (MIC), below neurotoxicity threshold (C(max)≤140mcg/mL), and duration limited to 48 hours. RESULTS: Among 34,689 newborns, all dosing regimens provided concentrations above MIC through 48 hours, but C(max) exceeded the neurotoxicity threshold. With the 4-dose standard regimen, >90% maintained concentrations >MIC beyond 48 hours. With the 2-dose regimen, newborns maintained the mean concentration >MIC within the 48-hour culture window and below neurotoxicity level. Infants 22–24 weeks’ gestation had higher drug concentrations and more prolonged exposure duration than 25–27 weeks’ gestation. CONCLUSIONS: For EOS in preterm infants, two ampicillin doses (50mg/kg) provided optimal bactericidal exposures, while minimizing potential toxicity. 2022-07 2022-02-24 /pmc/articles/PMC9262754/ /pubmed/35210541 http://dx.doi.org/10.1038/s41372-022-01344-2 Text en Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: https://www.springernature.com/gp/open-research/policies/accepted-manuscript-terms |
spellingShingle | Article Le, Jennifer Greenberg, Rachel G. Yoo, YoungJun Clark, Reese H. Benjamin, Daniel K. Zimmerman, Kanecia O. Cohen-Wolkowiez, Michael Wade, Kelly C. Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship |
title | Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship |
title_full | Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship |
title_fullStr | Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship |
title_full_unstemmed | Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship |
title_short | Ampicillin Dosing in Premature Infants for Early-onset Sepsis: Exposure-driven Efficacy, Safety, and Stewardship |
title_sort | ampicillin dosing in premature infants for early-onset sepsis: exposure-driven efficacy, safety, and stewardship |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262754/ https://www.ncbi.nlm.nih.gov/pubmed/35210541 http://dx.doi.org/10.1038/s41372-022-01344-2 |
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