Switch from intravenous-to-oral antibiotics in neonatal probable and proven early-onset infection: A prospective population-based real-life multicentre cohort study
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Switch from intravenous-to-oral antibiotics in neonatal probable and proven early-onset infection : A prospective population-based real-life multicentre cohort study. / Carlsen, Emma Louise Malchau; Dungu, Kia Hee Schultz; Lewis, Anna; Vissing, Nadja Hawwa; Aunsholt, Lise; Trautner, Simon; Stanchev, Hristo; Dayani, Gholamreza Krog; Pedersen, Anne Janet L.; Bjerager, Mia; De Salas, Maria; Vestergaard, Kristian; Pedersen, Pernille; Frimodt-Møller, Niels; Greisen, Gorm; Hansen, Bo Mølholm; Nygaard, Ulrikka.
I: Archives of Disease in Childhood: Fetal and Neonatal Edition, Bind 109, Nr. 1, 2024, s. 34-40.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Switch from intravenous-to-oral antibiotics in neonatal probable and proven early-onset infection
T2 - A prospective population-based real-life multicentre cohort study
AU - Carlsen, Emma Louise Malchau
AU - Dungu, Kia Hee Schultz
AU - Lewis, Anna
AU - Vissing, Nadja Hawwa
AU - Aunsholt, Lise
AU - Trautner, Simon
AU - Stanchev, Hristo
AU - Dayani, Gholamreza Krog
AU - Pedersen, Anne Janet L.
AU - Bjerager, Mia
AU - De Salas, Maria
AU - Vestergaard, Kristian
AU - Pedersen, Pernille
AU - Frimodt-Møller, Niels
AU - Greisen, Gorm
AU - Hansen, Bo Mølholm
AU - Nygaard, Ulrikka
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024
Y1 - 2024
N2 - Objective: To evaluate the implementation of switch from intravenous-to-oral antibiotic therapy with amoxicillin in neonates with early-onset infection (EOI). Design, setting and patients: A population-based multicentre cohort study. All term-born neonates with EOI were prospectively included between 1 December 2018 to 30 November 2020. Intervention: Intravenous-to-oral switch antibiotic therapy in clinically stable neonates. Main outcome measures: The primary outcome was readmission due to infection. Secondary outcomes were days of hospitalisation and antibiotic use in the pre-implementation versus post implementation period. Results: During 2 years, 835 neonates commenced antibiotics for EOI (1.5% (95% CI 1.4% to 1.6%)) of all term live births). Of those, 554 (66%) underwent a full course of treatment. There were 23 episodes of culture-proven infection (0.42 per 1000 term live births (95% CI 0.27 to 0.63)). A total of 478 of 531 (90%) neonates with probable infection underwent switch therapy. None was readmitted due to infection. The median duration of hospitalisation was 3.0 days (IQR 2.5-3.5) and 7.4 days (IQR 7.0-7.5) in the switch and intravenous therapy groups, respectively. According to antibiotic surveillance data, 1.2% underwent a full course of treatment following implementation of oral switch therapy (2019-2020), compared with 1.2% before (2017-2018). Conclusion: In clinical practice, switch therapy was safe and used in 9 of 10 neonates with probable EOI. Knowledge of the safety of antibiotic de-escalation is important as home-based oral therapy ameliorates the treatment burden for neonates, caregivers and healthcare systems. Despite the ease of oral administration, implementation of switch therapy did not increase the overall use of antibiotics.
AB - Objective: To evaluate the implementation of switch from intravenous-to-oral antibiotic therapy with amoxicillin in neonates with early-onset infection (EOI). Design, setting and patients: A population-based multicentre cohort study. All term-born neonates with EOI were prospectively included between 1 December 2018 to 30 November 2020. Intervention: Intravenous-to-oral switch antibiotic therapy in clinically stable neonates. Main outcome measures: The primary outcome was readmission due to infection. Secondary outcomes were days of hospitalisation and antibiotic use in the pre-implementation versus post implementation period. Results: During 2 years, 835 neonates commenced antibiotics for EOI (1.5% (95% CI 1.4% to 1.6%)) of all term live births). Of those, 554 (66%) underwent a full course of treatment. There were 23 episodes of culture-proven infection (0.42 per 1000 term live births (95% CI 0.27 to 0.63)). A total of 478 of 531 (90%) neonates with probable infection underwent switch therapy. None was readmitted due to infection. The median duration of hospitalisation was 3.0 days (IQR 2.5-3.5) and 7.4 days (IQR 7.0-7.5) in the switch and intravenous therapy groups, respectively. According to antibiotic surveillance data, 1.2% underwent a full course of treatment following implementation of oral switch therapy (2019-2020), compared with 1.2% before (2017-2018). Conclusion: In clinical practice, switch therapy was safe and used in 9 of 10 neonates with probable EOI. Knowledge of the safety of antibiotic de-escalation is important as home-based oral therapy ameliorates the treatment burden for neonates, caregivers and healthcare systems. Despite the ease of oral administration, implementation of switch therapy did not increase the overall use of antibiotics.
KW - Infant Welfare
KW - Infectious Disease Medicine
KW - Neonatology
KW - Sepsis
U2 - 10.1136/archdischild-2023-325386
DO - 10.1136/archdischild-2023-325386
M3 - Journal article
C2 - 37369601
AN - SCOPUS:85164417065
VL - 109
SP - 34
EP - 40
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
SN - 0003-9888
IS - 1
ER -
ID: 359789567