ABSTRACT OBJECTIVE: We changed from ampicillin and gentamicin (AG) to piperacillin–tazobactam (PT) for routine treatment of suspected early-onset sepsis. The rationale for this change

included ototoxic and renal toxic effects of gentamicin, resistance to gentamicin in late-onset infections and emergence of ampicillin resistant _Escherichia coli_. A before and after study

was designed before the start of PT administration to monitor whether PT was associated with altered outcomes within the 501 to 1500 g birth weight (Very Low Birth Weight) population.

METHOD: Both unmatched and matched comparisons of AG (2007 to 2009) and PT (2010 to 2011) exposed infants are reported. Cohorts were evaluated for initial effectiveness for congenital

both the matched and unmatched comparisons including less necrotizing enterocolitis (NEC) and less diaper rash with PT versus AG. The only adverse finding with PT was a small, but

statistically significant elevation in alkaline phosphatase. CONCLUSIONS: Use of PT as the initial empiric antibiotic for very low birth weight infants was not associated with adverse

microbiological outcomes. There was no increase in major morbidities. Although outcomes were superior in ⩽1500 g infants treated with PT when compared with AG, the study design does not

allow us to conclude that others will see a reduction in NEC or diaper rash if they implement this alternative. Access through your institution Buy or subscribe This is a preview of

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PREMATURE INFANTS FOR EARLY-ONSET SEPSIS: EXPOSURE-DRIVEN EFFICACY, SAFETY, AND STEWARDSHIP Article 24 February 2022 SHORT-COURSE EMPIRIC ANTIBIOTIC THERAPY FOR POSSIBLE EARLY-ONSET SEPSIS

IN THE NICU Article 22 February 2023 EARLY ANTIBIOTIC EXPOSURE IN VERY-LOW BIRTH WEIGHT INFANTS AND INFECTION RISK AT 3–7 DAYS AFTER BIRTH Article 25 July 2023 REFERENCES * Stoll BJ, Hansen

N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA _et al_. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. _N Engl J Med_ 2002; 347: 240–247. Article 

Google Scholar  * Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG . Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic

prophylaxis. _Pediatrics_ 2008; 121: 689–696. Article  Google Scholar  * Puopolo KM, Eichenwald EC . No change in the incidence of ampicillin-resistant, neonatal, early-onset sepsis over 18

years. _Pediatrics_ 2010; 125: e1031–e1038. Article  Google Scholar  * Marget W, Seeliger HP . Listeria monocytogenes infections–therapeutic possibilities and problems. _Infection_ 1988; 16:

S175–S177. Article  Google Scholar  * Hof H . An update on the medical management of listeriosis. _Expert Opin Pharmacother_ 2004; 5: 1727–1735. Article  CAS  Google Scholar  * Cotten CM,

Taylor S, Stoll B, Goldberg RN, Hansen NI, Sanchez PJ _et al_. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis

and death for extremely low birth weight infants. _Pediatrics_ 2009; 123: 58–66. Article  Google Scholar  * Alexander VN, Northrup V, Bizzarro MJ . Antibiotic exposure in the newborn

intensive care unit and the risk of necrotizing enterocolitis. _J Pediatr_ 2011; 159: 392–397. Article  Google Scholar  * Weintraub AS, Ferrara L, Deluca L, Moshier E, Green RS, Oakman E _et

al_. Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis. _J Perinatol_ 2012; 32: 705–709. Article  CAS  Google Scholar  * Sheffield MJ, Lambert DK, Baer VL,

Henry E, Butler A, Snow GL _et al_. Effect of ampicillin on bleeding time in very low birth-weight neonates during the first week after birth. _J Perinatol_ 2011; 31: 477–480. Article  CAS 

Google Scholar  * Sheffield MJ, Lambert DK, Henry E, Christensen RD . Effect of ampicillin on the bleeding time of neonatal intensive care unit patients. _J Perinatol_ 2009; 30: 527–530.

Article  Google Scholar  * Ealy M, Lynch KA, Meyer NC, Smith RJ . The prevalence of mitochondrial mutations associated with aminoglycoside-induced sensorineural hearing loss in an NICU

population. _Laryngoscope_ 2011; 121: 1184–1186. Article  CAS  Google Scholar  * Boles RG, Friedlich P . Should patients be screened for 12S rRNA mutations before treatment with

aminoglycosides? _Mitochondrion_ 2010; 10: 391–392. Article  CAS  Google Scholar  * Giapros VI, Cholevas VI, Andronikou SK . Acute effects of gentamicin on urinary electrolyte excretion in

neonates. _Pediatr Nephrol_ 2004; 19: 322–325. Article  Google Scholar  * Chiruvolu A, Engle WD, Sendelbach D, Manning MD, Jackson GL . Serum calcium values in term and late-preterm neonates

receiving gentamicin. _Pediatr Nephrol_ 2008; 23: 569–574. Article  Google Scholar  * Tugay S, Bircan Z, Caglayan C, Arisoy AE, Gokalp AS 2006 Acute effects of gentamicin on glomerular and

tubular functions in preterm neonates. _Pediatr Nephrol_ 21: 1389–1392. Article  Google Scholar  * Reese J, Veldman A, Shah L, Vucovich M, Cotton RB . Inadvertent relaxation of the ductus

arteriosus by pharmacologic agents that are commonly used in the neonatal period. _Semin Perinatol_ 2010; 34: 222–230. Article  Google Scholar  * Mtitimila EI, Cooke RW 2004 Antibiotic

regimens for suspected early neonatal sepsis. _Cochrane Database Syst Rev_ CD004495. * Clark RH, Bloom BT, Spitzer AR, Gerstmann DR . Empiric use of ampicillin and cefotaxime, compared with

ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death. _Pediatrics_ 2006; 117: 67–74. Article  Google Scholar  * Kuck NA, Jacobus

NV, Petersen PJ, Weiss WJ, Testa RT . Comparative _in vitro_ and _in vivo_ activities of piperacillin combined with the beta-lactamase inhibitors tazobactam, clavulanic acid, and sulbactam.

_Antimicrob Agents Chemother_ 1989; 33: 1964–1969. Article  CAS  Google Scholar  * Daley D, Mulgrave L, Munro R, Neville S, Smith H, Dimech W . An evaluation of the _in vitro_ activity of

piperacillin/tazobactam. _Pathology_ 1996; 28: 167–172. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Pediatrics, Tulane

University School of Medicine Pediatrics: Neonatology, New Orleans, LA, USA E Chong, J Reynolds, L Forur & P Gordon * Department of Pediatrics, Wesley Medical Center, Wichita KS, USA J

Shaw & P Delmore * Department of Pediatrics, Kansas University of School of Medicine-Wichita, Wichita KS, USA H Uner * Wichita Medical Research and Education Foundation, Wichita, KS, USA

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author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to P Gordon. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest. ADDITIONAL INFORMATION

Supplementary Information accompanies the paper on the Journal of Perinatology website SUPPLEMENTARY INFORMATION SUPPLEMENTARY APPENDIX (DOC 81 KB) RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Chong, E., Reynolds, J., Shaw, J. _et al._ Results of a two-center, before and after study of piperacillin–tazobactam versus ampicillin and

gentamicin as empiric therapy for suspected sepsis at birth in neonates ⩽1500 g. _J Perinatol_ 33, 529–532 (2013). https://doi.org/10.1038/jp.2012.169 Download citation * Received: 16

October 2012 * Revised: 03 November 2012 * Accepted: 07 November 2012 * Published: 17 January 2013 * Issue Date: July 2013 * DOI: https://doi.org/10.1038/jp.2012.169 SHARE THIS ARTICLE

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by the Springer Nature SharedIt content-sharing initiative KEYWORDS * necrotizing enterocolitis * ampicillin * gentamicin * piperacillin–tazobactam * diaper rash