Prophylactic antibiotics ?

[JACK]

There is nice review of the efficacy of Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates.

1. Lodha A, Furlan AD, Whyte H, Moore AM. Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates: a systematic review. J Perinatol. 2008 Apr 10;28(8):526-533.

LINK TO THIS FREE ARTICLE (http://www.nature.com/jp/journal/v28/n8/full/jp200831a.html)

Do you use prophylactic antibiotis in your NICU? If yes, then in which patients? What has been your experience?
Do share it with us...

[Stefan Johansson]

We do not have a protocol for such treatment. On the other hand, most of our extremely preterm infants are given antibiotics from the start (due to a suspicion of infectious etiology of preterm labour/PPROM, due to invasive procedures like UACs/UVCs).

Our drugs of choice are bensyl-pencillin and gentamycin.

A problem with antibiotic treatment is that it is more easy to start than to withdraw... many of our preterm infants are treated for long times.

What is your criteria for stopping ab treatment?

[JACK]

We also start all our small premies on Ampicillin and amikacin.

Though ideally the point of withdrawal of antibiotics would be on day 5 when the Blood c/s result comes no growth. However this happens very rarely, as any slightest symptom in the baby is given importance and antibiotics are not withdrawn. Because we have some nasty gram negative bacteria 'residing' in our NICU, we have a very low threshold of adding Imipenem in any baby with central line who has anything out of the ordinary.

You are right...So easy to start yet so hard to stop.

[adaniel]

we usually start our preterm babies with antibiotics ( crystaline penicillin and gentamycin) if there is any suspicion of infection ,RDS etc and monitor the babies general condition and lab reports and monitor with repeat CRP and if the blood c/s and 2or 3 CRP reports and cBC normal we usualy discontinue the antibiotics by 3-5 days.We never use prophylatic antibiotic for central venous lines(UAC/UVC).

Alex Daniel
Specialist neonatologist
Al Ain Hospital

[JAMA]

My Q to u is what is ur unit rate of cath related infection?

[JAMA]

I think if you strictly follow the aseptic rules, the rate of CRBI will be low which become not a cost effective recommendation. if still in your unit high rate of CRBI this may be justifiable.
do you agree?

Jasim

[hehady]

Do you have experience with antibiotic lock. We have finnished a study on antibiotic lock using amikacin-heparin for neonates with extended UVC use and it was successful.

[JAMA]

Very interesting, can you give us more details on your study.

[hehady]

The study will be published soon and then I'll write the abstract in this forum once I recieve the acceptance.