Hall M A, Ducker D A, Lowes J A, McMichael J, Clarke P, Rowe D, Gordon A, Cole D S
Princess Anne Hospital, Southampton.
Drugs. 1988;35 Suppl 2:169-77. doi: 10.2165/00003495-198800352-00036.
In an open prospective study performed in 2 neonatal units, infants with suspected neonatal sepsis (SNS) of unknown microbial cause were randomly allocated to receive treatment with either cefotaxime (CTX) or netilmicin plus penicillin (N + P). 236 patients were entered into the trial, of whom 222 were evaluable. The number of 'definitely' and 'probably' infected babies was similar in both groups. There was no difference in clinical outcome between patients in the 2 treatment groups and no side effects were recorded for either of the antibiotic regimens. Antibiotic sensitivity testing of bacterial isolates from peripheral sites showed almost universal sensitivity of potential pathogens to both antibiotic regimens at the start of treatment in all infants. Thereafter, organisms resistant to CTX were isolated from patients in both treatment groups, possibly reflecting the antibiotic sensitivity profile of the colonising bacteria in both neonatal units. The results of this study indicate that either CTX or N + P are suitable, in our units, for the 'blind' treatment of early SNS. In units where listerial infections are prevalent, specific cover should be added to CTX. For SNS developing after admission, the choice of antibiotics will depend upon the background antibiotic sensitivity profile of the colonising bacteria.
在两项新生儿病房开展的开放性前瞻性研究中，将病因不明的疑似新生儿败血症（SNS）婴儿随机分为两组，分别接受头孢噻肟（CTX）或奈替米星加青霉素（N + P）治疗。236例患者进入试验，其中222例可评估。两组中“肯定”和“可能”感染的婴儿数量相似。两个治疗组患者的临床结局无差异，两种抗生素治疗方案均未记录到副作用。治疗开始时，对所有婴儿外周部位细菌分离株进行的抗生素敏感性测试显示，潜在病原体对两种抗生素治疗方案几乎均普遍敏感。此后，在两个治疗组的患者中均分离出对CTX耐药的微生物，这可能反映了两个新生儿病房中定植菌的抗生素敏感性情况。本研究结果表明，在我们的病房中，CTX或N + P均可用于早期SNS的“经验性”治疗。在李斯特菌感染流行的病房，应在CTX基础上加用针对性的覆盖药物。对于入院后发生的SNS，抗生素的选择将取决于定植菌的背景抗生素敏感性情况。
