מתוך medicontext.co.il
NEW YORK (Reuters Health) – A review of studies of febrile infants less than 3 months old shows that the empiric use of ampicillin in those less than 1 month of age is an effective approach, covering infections caused by Listeria monocytogenes and enterococcal bacteria.
The review of 14 studies, conducted by Dr. Julie C. Brown and associates at the University of Washington at Seattle, is published in the January issue of the Archives of Pediatrics and Adolescent Medicine.
The analysis included a total of 5,247 febrile infant outpatients. Dr. Brown's team found that L. monocytogenes and enterococcal infections accounted for 7.3 episodes per 1000 among infants less than 1 month of age, 1.9/1000 episodes in infants 2 months of age and 5.6/1000 episodes in infants 3 months of age.
"The yield of Listeria infections drops around 30 days, and that is the more virulent of the two organisms needing ampicillin," Dr. Brown told Reuters Health. "Look at the number of patients you would need to treat in each age group to pick up one infection best treated with ampicillin." Those numbers, reported in the paper, are 138 in the first month, 527 in the second month, and 178 in the third.
"We believe the use of ampicillin to cover for Listeria and enterococcal infections is still justified in the first month of life," the authors write. "In this age range, 1 out of every 439 outpatient infants with fever will have a L. monocytogenes infection, which causes high morbidity and mortality, potentially benefitting from expedient therapy with ampicillin."
"In the 30-60 day age range, there is considerable practice variation by institution, which so often happens when more evidence is needed to support one practice or another," Dr. Brown added.
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