Emergence of resistance in gram-negative bacteria: a risk of broad-spectrum beta-lactam use

Drug Therapy in Neonatal Sepsis

Despite the remarkable technological advances in neonatal intensive care, bacterial infections continue to be a significant cause of neonatal morbidity and mortality. The clinical manifestations of sepsis are frequently subtle and nonspecific. Progression of the disease is rapid and mortality continues to be high. Antimicrobial therapy must be instituted as soon as possible after symptomatic and high risk infants are identified. Empiric broad spectrum antibiotic therapy is initiated to cover the most likely pathogens that are etiologic in neonatal sepsis. Pathogen specific therapy is guided by the isolation and identification of the infecting organism and its susceptibility patterns. The clinical status of the infant must be closely monitored, and basic supportive care provided to optimize the infants chance of survival. The emergence of drug resistance and adverse drug reaction profiles may further dictale which antimicrobial regimen is the safest and most effective. Unconventional therapies should be reserved for the most critically ill infants after conventional treatment has failed. Controlled trials of pharmacologic and nonpharmacologic treatment modalities for neonatal sepsis are needed to optimize the management of these infants.

Use of new beta-lactam antibiotics for surgical infections

The availability of beta-lactam antibiotics with extended spectra of activity against organisms commonly seen in surgical infections suggests that aminoglycoside-based therapy is no longer needed for most such community-acquired infections. The primary problems with specific beta-lactams are lack of activity against Bacteroides species and variable activity against Pseudomonas aeruginosa and enterococci. The pharmacokinetic properties of the newer beta-lactams vary considerably. This variation suggests specific settings in which these properties may be taken advantage of to improve clinical outcome.