Antibiotics In Newborns

The absence of or the lack of certain enzymes in neonates causes some antibiotics (chloramphenicol) in a prolonged half-life and increases the risk of toxicity. Changes in the glomerular filtration rate and renal tubular secretion during the first month of life make with other drugs that are renally excreted, a dosage adjustment is necessary (penicillin, aminoglycosides, vancomycin).

In newborns, the Extrazellullärraum accounts for 45% of total body weight and requires antibiotics for some a higher dose than (z. B. aminoglycosides) in adults. The low serum albumin concentration in preterm infants may reduce the protein binding of the antibiotic. Drugs that dissolve the bilirubin protein binding (sulfonamides, ceftriaxone), increase the risk of kernicterus. The absence of or the lack of certain enzymes in neonates causes some antibiotics (chloramphenicol) in a prolonged half-life and increases the risk of toxicity. Changes in the glomerular filtration rate and renal tubular secretion during the first month of life make with other drugs that are renally excreted, a dosage adjustment is necessary (penicillin, aminoglycosides, vancomycin). Recommended doses of selected antibiotics pareneraler neonatal dosing interval antibiotic mode of administration single dose body weight <1200 g body weight 1200-1999 g body weight ? 2000 g Comments Age Age Age ? 7 days 8-28 days ? 7 days 8-28 days ? 7 days 8-28 days amikacin * i.v., i.m. 15 mg / kg every 48 h every 24-48 h every 48 h every 24-48 h every 24 h every 12-24 h monitoring the serum concentration is required (maximum = 20-30 ug / ml; Minimum = <10 ug / ml ) a reduction of the dose in renal function required for longer dosing intervals can as a single dose of 15-20 mg / kg of 1-times daily or 1 times every 48 h amphotericin B deoxycholate 0.25-1.5 IV mg / kg strength or after dilution in 5% 10% D / W (brine should not be used), Inf usion of a test dose of 0.1 mg / kg (maximum 1 mg) over 1 hour in patients with febrile and hemodynamic responses; † if no serious side effects are observed, the infusion of a therapeutic dose can (usually 0.25 1.5 mg / kg over 2-6 h) are given on the same day as the challenge dose. After the patient's condition has improved, the dose can be given every 2 days until the therapy completed all 6 is a monitoring of the K-levels and hematologic and kidney functions required Ampicillin for meningitis IV 75 mg / kg every 6 h h every 6 h every 6 h every 6 h every 6 h i.v. For other diseases, i.v. than 15-30 minutes infusion (? 10 mg / kg / min), i.m. 50 mg / kg every 12 h every 8 h every 12 h every 8 h every 8 h every 6 h Aztreonam i.v., i.m. 30 mg / kg every 12 hours every 12 hours every 8-12 h every 6-8 h i.v. Little ‡ exclusively for gram-negative rods excitation cefazolin every 12 h every 8-12 h reliable data, i.m. 20-25 mg / kg every 12 hours every 12 hours every 12 hours every 12 hours every 12 hours every 8 h Little No reliable data primary indication, not i.v. as initial therapy for sepsis or meningitis Cefepime, i.m. 30-50 mg / kg every 12 h every 8-12 h every 12 h every 8-12 h 8-12 h all be used every 8-12 h Can for infections with Pseudomonas aeruginosa (it can, if necessary, a dose of 50 mg / kg every 8 hours for P. aeruginosa and other serious gram-negative pathogens are dosed) is sometimes used in meningitis, although usually as a second-choice drug and not always recommended cefotaxime iv, im 50 mg / kg every 12 h every 8 h every 12 h every 8 h every 12 h for meningitis, every 8-12 h every 8 h for meningitis every 6-8 h Is often is the preferred therapy for neonatal meningitis iv Ceftazidime, in the 50 mg / kg every 12 h every 8 h every 12 h every 8 h every 12 h every 8 h penetrates also in inflamed meninges a 70-90% of the drug is excreted unchanged in the urine ceftriaxone i.v., i.m. 50 mg / kg every 24 hours every 24 hours every 24 hours every 24 hours every 24 hours Little every 24 h reliable data can Pseudolithiasis biliary tract cause, and can increase the risk of bilirubin via the displacement of albumin to bilirubin in premature neonates with jaundice. are contraindicated receive or obtain in newborns, the infusions of Ca-containing solutions. Drug second choice for meningitis after the first week of life (40-50 mg / g every 12 h or 80-100 mg / kg every 24 h) Chloramphenicol IV 25 mg / kg every 24 hours every 24 hours every 24 hours every 12-24 h every 24 h 12 h all doses must be adjusted while monitoring the serum concentration and hematological parameters for optimal meningitis: maximum serum values ??= 15-25 ug / ml and minimum values ??= 5-15 ug / ml for other infections is the dose adjusted so that a maximum value of 10-20 ug / ml and a minimum value of 5-10 ug / ml is achieved. Great variability in serum levels and serum half-life, especially in preterm infants clindamycin i.v., i.m. 5 mg / kg every 12 hours every 12 hours every 8 h every 6 h for anaerobic and gram-positive cocci (not enterococci) Gentamycin * / tobramycin i.v. every 8 h every 12 h, i.m. 4-5 mg / kg every 48 h every 24-48 h every 36 h every 24-48 h every 24 h every 12-24 h monitoring of blood concentrations required (maximum = 5-12 ug / ml; Minimum = <2 ug / ml) A reduction of the dose is required meropenem IV 20-40 mg / kg in renal function every 12 h every 8 h every 12 h every 8 h every 8 h every 8 h in Mening itis higher doses used metronidazole IV 15 mg / kg (7.5 mg / kg for newborn ? 7 days and <1,200 g) every 24-48 h every 24-48 h every 24 hours every 24 hours every 24 hours every 12 h little reliable data initial dose of 15 mg / kg, then a subsequent dose 48 hours later in premature infants nafcillin / oxacillin In meningitis or endocarditis IV 50 mg / kg every 12 hours every 12 hours every 12 hours every 8 h every 8 h every 6 h monitoring of blood counts and liver function required Excretion can be reduced by renal and hepatic immaturity, leading to a possible accumulation in leads serum, which is potentially harmful. For other diseases, i.v., i.m. 25 mg / kg every 12 h every 8-12 h every 12 h every 8 h every 8 h every 6 h oxacillin (s nafcillin / oxacillin.) - - - - - - - - - Penicillin G, watery every 12 hours every 12 hours every 12 hours every 8 h every 8 h all 6 B = meningitis For most other diseases for i.v. meningitis IV 50,000-75,000 units / kg h maximum for Streptococcus Group 450,000 units / kg / day, i.m. 25,000 units / kg every 12 hours every 12 hours every 12 hours every 8 h every 8 h every 6 h penicillin G, procaine i.m. 50,000 units / kg Not recommended Not recommended every 24 hours every 24 hours every 24 hours every 24 hours Warning: Sterile abscess and procaine toxicity Piperacillin / Tazobactam i.v. (Dose based on the piperacillin component) 100 mg / kg every 12 hours every 8 hours every 12 hours every 8 hours every 12 hours every 8 h Can accommodate up to 100 mg / kg every 6 hours be increased in infants> 28 days tobramycin ( s gentamicin / tobramycin). – – – – – – – – – Vancomycin (see table: vancomycin dosage for newborns) – – – – – – – – dosing based on gestational age and serum creatinine (see table: vancomycin dosage for newborns) * The sample should be 30 minutes after a received 30-min infusion become. † The procedure to administer a test dose of Amphotericin B, is controversial. ‡ Cefazolin not cross the blood-brain barrier. Vancomycin-dose for newborn serum creatinine (mg / dL) Dose * (iv) dosing interval ? 28 SSW> 28 SSW <0.5 <0.7 15 mg / kg every 12 h 0.5-0.7 0.7 -0.9 20 mg / kg every 24 h 0.8-1 1-1.2 15 mg / kg every 24 hours 1.1-1.4 1.3-1.6 10 mg / kg every 24 h> 1.4> 1.6 15 mg / kg every 48 h * The dose by slow iv Infusion given over at least 60 min. Monitoring of serum levels recommended (Minimum = 10-15 ? / ml). Recommended dosage of selected oral antibiotics for newborns * antibiotic dosing interval Comments Amoxicillin 10-15 mg / kg every 12 hours Little reliable data azithromycin 5-10 mg / kg every 24 hours Preferred drugs for the treatment or prevention of pertussis in neonates <1 month To treat or prevention of pertussis, 10 mg / kg once / T ag 5 days for most other infections: 10 mg / kg on Day 1 and 5 mg / kg on days 2-5 following clindamycin † 5 mg / kg every 6-12 hours Little reliable data erythromycin ethylsuccinate 10-12, 5 mg / kg every 6-12 hours for chlamydia infections or pertussis in neonates> 1 month Connected with idiopathic hypertrophic pyloric stenosis fluconazole 3-12 mg / kg every 24-72 hours in schw ächeren Candid infections: 6 mg / kg on day one, then a dose of 3 mg / kg / every 24-72 hours for severe infections: 12 mg / kg 1 time recommended a first (for all gestational and postnatal age on the day initial) dose of 25 mg / kg may be considered for the first 2 weeks of life: adjustment of the dosing interval may be necessary if the kidney function is abnormal flucytosine 12.5 to 37.5 mg / kg every 6 h little reliable data only with to use amphotericin B to recommend the emergence of resistance to slow monitoring the mirror For newborns <2000 g and <7 days 25 mg / kg every 8 h Linezolid 10 m g / kg every 8 to 12 h Can i.v. Will be given or orally in resistant gram-positive infections applied rifampicin 10 mg / kg every 24 h in tuberculosis 5 mg / kg every 12 hours at meningococcal prophylaxis: treatment over 2 days 10 mg / kg every 24 h for Haemophilus influenzae prophylaxis: Treatment Unless otherwise specified over 4 days * are d ie doses for newborns> 7 days and> 2000 g. † The dose for newborns <7 days and <2000 g is 5 mg / kg every 12 hours.

Health Life Media Team

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