Abstract
Aim: To analyse antibiotic prescriptions in a cohort of extremely low birth weight neonates admitted to Italian level III Neonatal intensive Care Units. Methods: An online questionnaire was used to collect detailed information for each newborn. Antibiotic prescriptions were classified about their license status and compared with British National Formulary for Children (BNFC) and with a practical guide prepared by the Italian Society of Neonatology (ISN). Results: During the study period (May-July 2014) among 93 neonates admitted to 30 Italian Neonatal intensive Care Units, 56 (60%) received at least an antibiotic (92 prescriptions in total). Ampicillin, gentamicin and vancomycin were the antibiotics most commonly used for the prevention/treatment of bacterial infections. 56/92 antibiotic prescriptions (61%) resulted off-label mainly as regards dosing frequency, while 13 prescriptions (14%) regarded antibiotics used in absence of specific indication for newborns (meropenem, imipenem, piperacillin/tazobactam, clindamycin, clarithromycin). 50/56 neonates (89.3%) received at least one off-label antibiotic prescription. Differences have been observed in dosing regimens between current study and recommendations contained in BNFC, while prescriptions adhered more frequently to ISN indications. Conclusions: Our results confirm the high prevalence of off-label antibiotic use in ELBW neonates and underline a better adherence to indications based on clinical practice.
Highlights
IntroductionAgostino (BW ≤ 1000 g) has improved dramatically due to advances in perinatal and neonatal care and better understanding of their physiopathology [1]
Ampicillin, gentamicin and vancomycin were the antibiotics most commonly used for the prevention/treatment of bacterial infections. 56/92 antibiotic prescriptions (61%) resulted off-label mainly as regards dosing frequency, while 13 prescriptions (14%) regarded antibiotics used in absence of specific indication for newborns. 50/56 neonates (89.3%) received at least one off-label antibiotic prescription
Among the 36 Neonatal Intensive Care Units (NICUs) participating to the multicentre study (34% of all Italian level III NICUs, comprising hospital and academic wards) [16], 30 wards admitted extremely low birth weight (ELBW) neonates: each NICU participating in this study recorded a median number of six charts and should be considered representative of the regional distribution and of the number of beds/ward
Summary
Agostino (BW ≤ 1000 g) has improved dramatically due to advances in perinatal and neonatal care and better understanding of their physiopathology [1]. These neonates, characterized by a great immaturity, are more exposed to risks to develop different morbidities [1] and in particular are vulnerable to bacterial and fungal infections (up to one third develop hospital acquired infections) due to the immaturity of the immune system and to predisposing factors such as maternal chorioamnionitis, ventilator care, catheterization and total parenteral alimentation [2]. Empirical therapy should be applied only when necessary at the best possible option [6] [7]
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