Congenital Pneumonia Medication

Updated: Mar 01, 2016
  • Author: Muhammad Aslam, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Medication

Medication Summary

The frequency of bacterial infection as the primary cause or as a superimposed complication of pulmonary inflammation in general, and congenital pneumonia in particular, usually mandates antibiotic administration as the cornerstone of therapy.

Agents typically used initially include a combination of ampicillin and either gentamicin or cefotaxime. The selection of cefotaxime or gentamicin must be based on experience and considerations at each center and in each patient. Combination therapy provides reasonable antimicrobial efficacy against the pathogens that typically cause serious infection in the first days of life.

Other agents or combinations may be appropriate for initial empiric therapy if justified by the range of pathogens and susceptibilities encountered in a particular clinical setting.

Consultation of appropriate neonatal references, such as Neofax, is recommended when using antibiotics in these patients. Similarly, an appropriate reference should be used when using adjunctive therapy such as bronchodilators, mucolytics, nitric oxide, or epoprostenol.

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Antibiotics

Class Summary

The frequency of bacterial infection as the cause or a major complication of congenital pneumonia usually mandates antibiotics as a cornerstone of therapy.

Ampicillin

This parenteral agent offers antimicrobial efficacy against many pathogens encountered in infections that occur in the first few days of life, including, but not limited to, group B Streptococcus, many types of other streptococci, L monocytogenes, and some strains of E coli, enterococci, and nontypeable H influenzae.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with gram-negative spectrum. Cefotaxime arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth. When administered parenterally, this agent offers antimicrobial efficacy against many gram-negative pathogens that are commonly encountered in the first few days of life, including E coli, nontypeable H influenzae, Klebsiella species, and other enteric organisms. Cefotaxime crosses the blood-brain barrier into the CNS reasonably well and theoretically poses less risk of renal toxicity or ototoxicity than gentamicin and other aminoglycosides, which are the common alternatives. It is less likely than gentamicin to interfere with function of neuromuscular junction in infants born to mothers with myasthenia gravis.

However, compared with gentamicin, cefotaxime is more costly, is associated with much more rapid emergence of resistant organisms in a closed environment (eg, NICU), covers a slightly narrower range of gram-negative organisms, and has not been demonstrated to yield superior outcomes in a randomized controlled trial of neonatal patients.

Gentamicin

Gentamicin is an aminoglycoside antibiotic used for gram-negative coverage. Gentamicin is typically used in combination with agents against gram-positive organisms. When administered parenterally, this agent offers antimicrobial efficacy against many gram-negative pathogens commonly encountered in the first few days of life, including E coli, Klebsiella species, and other enteric organisms, as well as many strains of nontypeable H influenzae. It is also variably effective against some strains of certain gram-positive organisms, including S aureus, enterococci, and L monocytogenes.

Gentamicin crosses the blood-brain barrier into the CNS less well and theoretically poses greater risk of renal toxicity or ototoxicity than cefotaxime and other third-generation cephalosporins, which are the common alternatives. Compared with cefotaxime, gentamicin is less costly, is associated with much less rapid emergence of resistant organisms in a closed environment (eg, NICU), and covers a broader range of gram-negative organisms.

Gentamicin has been reported to offer additive or synergistic activity against enterococci when used with ampicillin.

Azithromycin

Empiric use of azithromycin or other macrolides for presumed Ureaplasma infection is not currently evidence based and should be reserved for infants who have that organism recovered from a normally sterile site or who are critically ill and do not have a more likely cause of infection. Azithromycin acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected. It concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.

Erythromycin (Ery-Tab, Erythrocin, EryPed, E.E.S.)

Erythromycin is a macrolide antibiotic with a large spectrum of activity. Erythromycin binds to the 50S ribosomal subunit of the bacteria, which inhibits protein synthesis.

Like azithromycin, the use of erythromycin for presumed Ureaplasma infection is not currently evidence based and should be reserved for infants who have that organism recovered from a normally sterile site or who are critically ill and do not have a more likely cause of infection.

Orally administered erythromycin has been associated with the development of infantile hypertrophic pyloric stenosis in infants younger than 1 month.

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Antivirals

Class Summary

Antiviral agents interfere with viral replication and weaken or abolish viral activity. An example of an antiviral agent is acyclovir (Zovirax).

Acyclovir (Zovirax)

Acyclovir treatment should be considered when a diagnosis of herpes simplex virus is suspected and when the infant is not responding to antibiotic therapy.

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