Are You Going Overboard on Cephalosporins?

The study

This prospective chart review study (2011–2013) from Texas included infants aged ≤60 days with a positive culture from the blood, urine, or cerebrospinal fluid. The researcher’s objectives were to study the pathogens and the optimal choice of antibiotics in infants with serious bacterial infection (SBI).

The key findings

The study found 265 infants with SBI. Of those infants, 11% had meningitis, 25% had bacteremia or bacteremia with urinary tract infection, and 64% had urinary tract infection alone. Escherichia coli and group B Streptococcus were the predominate pathogens. There were no cases of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, or penicillin-resistant Streptococcus pneumonia. For infants aged ≤28 days, the combination of ampicillin and gentamicin was used in 78% of cases, whereas a third-generation cephalosporin was used in 22% of cases. For infants aged ≥29 days, ampicillin and gentamicin were used in 13% of cases, and a third-generation cephalosporin was used in 87% of cases.

The authors noted that when meningitis was not suspected, regimens of either ampicillin/gentamicin or a third-generation cephalosporin were equally effective based on susceptibility data (96% and 97%). They also noted that 67% of cases in which a third-generation cephalosporin was used resulted in unnecessarily broad coverage compared with ampicillin/gentamicin. Also, …