Medication Summary
Antibiotics are used to treat occult bacterial infection. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens for the patient's age range and in the clinical setting. Whenever feasible, select antibiotics based upon blood culture sensitivity.
Antimicrobials
Class Summary
Empiric antimicrobial therapy must provide coverage against the suspected pathogens for a given age group, and treatment must achieve high and sustained serum concentrations (see Treatment).
Ampicillin
Ampicillin is a beta-lactam antibiotic that is bactericidal for susceptible organisms, such as group B Streptococcus (GBS), Listeria, non–penicillinase-producing Staphylococcus, some strains of Haemophilus influenzae, and meningococci. Reports have indicated ampicillin (in combination with gentamicin) is the first-line therapy for suspected sepsis in the newborn.
Gentamicin
Gentamicin is an aminoglycoside that is bactericidal for susceptible gram-negative organisms, such as Escherichia coli and Pseudomonas, Proteus, and Serratia species. This agent is effective in combination with ampicillin for group B Streptococcus (GBS) and Enterococcus. Reports have indicated gentamicin (in combination with ampicillin) is the first-line therapy for suspected sepsis in the newborn.
Cefotaxime (Claforan)
Cefotaxime is a third-generation cephalosporin with excellent in vitro activity against group B Streptococcus (GBS) and Escherichia coli and other gram-negative enteric bacilli. This agent has good serum and cerebrospinal fluid (CSF) concentrations. However, concern exists about the emergence of drug-resistant gram-negative bacteria at a more rapid rate than with traditional penicillin and aminoglycoside coverage. In addition, cefotaxime is ineffective against Listeria and enterococci; use in combination with ampicillin. In more recent publications, this drug is not a first-line agent for neonatal sepsis because of its association with increased mortality.
Vancomycin (Vancocin)
Vancomycin is a bactericidal agent against most aerobic and anaerobic gram-positive cocci and bacilli; this is especially important in the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is recommended therapy when coagulase-negative staphylococcal sepsis is suspected. Therapy with rifampin and/or gentamicin may be required with endocarditis or cerebrospinal fluid (CSF) shunt infection by coagulase-negative Staphylococcus.
Ceftriaxone (Rocephin)
Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; and higher efficacy against resistant organisms. The bactericidal activity of this drug results from inhibiting cell wall synthesis by binding to one or more penicillin binding proteins; ceftriaxone exerts antimicrobial effect by interfering with the synthesis of peptidoglycan, a major structural component of bacterial cell wall. Bacteria eventually lyse due to the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.
Ceftriaxone is highly stable in the presence of beta-lactamases, both penicillinase and cephalosporinase, of gram-negative and gram-positive bacteria. Approximately 33-67% of the drug dose is excreted unchanged in urine, and the remainder is secreted in bile and ultimately in feces as microbiologically inactive compounds. Ceftriaxone reversibly binds to human plasma proteins, and binding has been reported to decrease from 95% bound at plasma concentrations < 25 mcg/mL to 85% bound at 300 mcg/mL.
Clindamycin (Cleocin)
Clindamycin is a semisynthetic antibiotic produced by the 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin. This agent inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Clindamycin widely distributes in the body without penetration of the central nervous system (CNS); this drug is protein bound and excreted by the liver and kidneys.
Clindamycin is used for treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci).
Antivirals
Class Summary
Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase.
Acyclovir (Zovirax)
Acyclovir is a prodrug activated by phosphorylation by virus-specific thymidine kinase that inhibits viral replication. The Herpes virus thymidine kinase (TK), but not host cells TK, uses acyclovir as a purine nucleoside, converting it into acyclovir monophosphate, a nucleotide analogue. Guanylate kinase converts the monophosphate form into diphosphate and triphosphate analogues that inhibit viral DNA replication.
Acyclovir has affinity for viral TK and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase. This drug inhibits the activity of both Herpes simplex virus type 1 (HSV-1) and HSV-2. Patients experience less pain and faster resolution of cutaneous lesions when acyclovir is used within 48 hours from rash onset. This agent may prevent recurrent outbreaks. Early initiation of therapy is imperative.
Antipyretics
Class Summary
These agents act on the hypothalamus to produce antipyresis.
Ibuprofen (Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB)
NSAID that is indicated for reduction of fever.
Ibuprofen IV (Caldolor)
Indicated for management of mild-to-moderate pain, management of moderate-to-severe pain as an adjunct to opioid analgesics, and fever reduction in patients aged 3 months and older.
Acetaminophen (Tylenol, Little Fevers Children's Fever/Pain Reliever, Little Fevers Infant Fever/Pain Reliever)
Indicated for reduction of fever. Caution when administering as the various oral liquid products are available in a variety of dosage concentrations. Carefully calculate dosage and volume of dose according to specific product.
Acetaminophen IV (Ofirmev)
Indicated for reduction of fever in children, infants, and neonates, including premature neonates born at ≥32 weeks gestational age.
