Comparative efficacy of ceftazidime vs. carbenicillin and amikacin for treatment of neonatal septicemia

Abstract

The efficacy and safety of ceftazidime were compared with those of carbenicillin and amikacin in 60 neonates with proved invasive bacterial infections. The two treatment groups of patients were comparable with regard to sex, gestational and chronologic ages, associated risk factors, clinical condition on enrollment, focus of infection and bacteriology. Escherichia coli was isolated from blood cultures of 31%, Pseudomonas aeruginosa from cultures of 25%, Klebsiella sp. from cultures of 13% and other Gram-negative enteric bacilli from cultures of 17% of the patients. Staphylococcus aureus was isolated from 20% (12 of 60), and coagulase-negative staphylococci from 8% (5 of 60) of the patients. All Gram-negative coliform bacilli were susceptible to ceftazidime whereas 10, 56 and 77% were resistant to amikacin, carbenicillin and ampicillin, respectively. Serum bactericidal activity against the offending pathogen was as much as 5-fold greater in ceftazidime-treated compared with conventionally treated patients. Seven patients with infections caused by organisms resistant to the study drugs were excluded from analysis. Case-fatality rates were 6.4% (2 of 31) and 21% (6 of 28) in the ceftazidime- and amikacin/carbenicillin-treated patients, respectively. Total failure rates, including deaths, were significantly higher in patients treated with amikacin/carbenicillin (8 of 28, 28.5%) compared with that of ceftazidime-treated patients (2 of 31, 6.4%). Thirteen percent (5 of 31) and 3% (1 of 28) of the ceftazidime- and amikacin/carbenicillin-treated patients, respectively, developed invasive Candida albicans superinfection while receiving treatment. In this study results of treatment with ceftazidime were superior to results of treatment with amikacin/carbenicillin for invasive bacterial infections of newborn infants.(ABSTRACT TRUNCATED AT 250 WORDS)