antibiotics

[rockabye]

I was hoping to get some clarification on how doctors will choose to treat suspected infections with amp, gent, tobra, or vanc. This is before the blood cultures come back. Do you know why newborns suspected of infection at birth will get amp and gent first instead of the other antibiotics? Do the antibiotics prescribed depend on the gestation and age of the patient? For example, premature patient with no prenatal care is born and started on amp and gent combo for a couple days until blood cultures come back negative. Then a few days later he is suspected of medical NEC and blood cultures are taken and he is put on vanc and tobra. Just wondering why it isn't amp and gent again.

[I'mANurse!]

Amp and gent are used while awaiting blood culture results because they are broad spectrum antibiotics, meaning they cover many different types of bacteria. Once a culture comes back positive, the medication will be adjusted based upon the organism identified (gram pos, neg, staph, etc) and will be specific enough to treat what the baby actually has. Hope that helps!

[littleneoRN]

To just add to the previous poster, who is right, antibiotics are chosen to have a broad spectrum until an organism is identified. However, depending on the timeframe (birth, post-op, etc.) and presenting symptoms (fever? questionable NEC?), there are certain more likely organisms. So with your questions about the preemie with r/o sepsis and then r/o NEC, the antibiotic choice is based on the most likely possible culprits.

[PharmDoc]

I would like to add my $0.02 to what has been said previously here. The previous respondent is correct in stating that the empiric treatment for neonatal sepsis prophylaxis w/gent and amp is due to the broad coverage of these 2 antimicrobials in the absence of specific C&S results. However, the rationale for such a selection is absent from the above response. The reason ampicillin is given preferentially as opposed to other beta-lactams such as amoxicillin or penicillin, is exclusively for listeria monocytogenes coverage, a common early onset infection found in the southeastern US, so amp is given indiscriminately to all neonates regardless of clinical presentation to cover this possibility. As stated above once C&S is received from the lab then the antibiotics will be chosen based on the findings such as vanc for MRSA, etc. Hope this helps to elucidate the actual rationale for why docs treat with these 2 drugs specifically and thank you for reading.

[KRVRN, BSN, RN]

Early-onset sepsis vs. Late-onset sepsis (>72 hrs old at my work).

They choose the antibiotics that are standard of care for whichever one it is.

[jnick31]

These are all great responses, so many smart people out there... a question to the op, I may be way off point here but you sound fairly new to the NICU. I would encourage you to build a relationship with your Neo's or NNP's that you would feel comfortable approaching them with questions such as this.

[jnick31]

hahaha, just realized this post was orig. from 2011. :/ oops.