Considerations in the pharmacologic treatment and prevention of neonatal sepsis.

摘要: The management of neonatal sepsis is challenging owing to complex developmental and environmental factors that contribute inter-individual variability in the pharmacokinetics pharmacodynamics many antimicrobial agents. In this review, we describe (i) changing epidemiology early- late-onset sepsis; (ii) pharmacologic considerations influence safety efficacy antibacterials, antifungals, immunomodulatory adjuvants; (iii) recommended dosing regimens for agents commonly used treatment prevention sepsis. Neonatal marked by high morbidity mortality, such prompt initiation therapy essential following culture collection. Before results are available, combination with ampicillin an aminoglycoside recommended. When meningitis suspected, cefotaxime may be considered. Following identification causative organism vitro susceptibility testing, narrowed provide targeted coverage. Therapeutic drug monitoring should considered neonates receiving vancomycin or therapies. For invasive fungal infections, development new antifungal has significantly improved therapeutic outcomes recent years. Liposomal amphotericin B been found safe efficacious patients renal impairment toxicity caused conventional B. Antifungal prophylaxis fluconazole also reported dramatically reduce rates infections improve long-term neurodevelopmental among treated children. Additionally, several large multicenter studies currently investigating oral lactoferrin as immunoprophylactic agent