Are postnatal ampicillin levels actually related to the duration of intrapartum antibiotic prophylaxis prior to delivery? A pharmacokinetic study in 120 neonates
Are postnatal ampicillin levels actually related to the duration of intrapartum antibiotic prophylaxis prior to delivery? A pharmacokinetic study in 120 neonates
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DOI：
10.1136/archdischild-2016-312546
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发表时间：
2018-03-01
影响因子：
4.4
通讯作者：
Ferrari, Fabrizio
中科院分区：
文献类型：
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作者：
Berardi, Alberto;Pietrangiolillo, Zaira;Ferrari, Fabrizio
目的根据分娩期抗生素预防（IAP）的持续时间评估氨苄青霉素水平。设计前瞻性队列单中心研究。（Modena，意大利）。患者120名妊娠≥ 35周的新生儿暴露于IAP。干预新生儿根据分娩前IAP的持续时间分为四组：（n = 30; < 1小时），第2组（n = 30; = 1和< 2小时），第3组（n = 30; = 2和< 4小时）和第4组（n= 30;= 2剂，在分娩时采集血样结果IAP平均持续时间为121 min（7-2045 min）。脐带血中的氨苄青霉素中位水平为10.4 μ g/mL（IQR 6.4-14.9），外周血中的氨苄青霉素中位水平为4.7 μ g/mL（IQR 2.8-6.4 μ g/mL）。脐静脉血在IAP后30分钟左右达到峰值，随后显著下降（p < 0.001）。研究组间外周血水平无差异。暴露于全负荷剂量的新生儿（n= 115）的外周血水平比B组链霉素的最小抑制浓度高2.5-70倍。新生儿氨苄青霉素浓度与分娩前IAP持续时间之间无相关性（β =-0.0003，95%CI-0.02至0.001，p = 0.680）。在完全负荷剂量后，杀菌水平在出生后持续至少4小时，并且似乎与分娩前IAP的持续时间无关。
Objective To assess ampicillin levels according to the duration of intrapartum antibiotic prophylaxis (IAP).Design Prospective cohort single-centre study.Setting Tertiary care centre (Modena, Italy).Patients 120 neonates >= 35 weeks' gestation exposed to IAP.Interventions Neonates were divided into four groups, according to the duration of IAP prior to delivery: group 1 (n = 30; < 1 hour), group 2 (n = 30; = 1 and < 2 hours), group 3 (n = 30; = 2 and < 4 hours) and group 4 (n= 30; = 2 doses, = 4 hours).Main outcome measures Blood samples were collected at delivery (from the umbilical cord) and at age 4 hours (from a peripheral vessel).Results Median duration of IAP was 121 min (range 7-2045 min). Median ampicillin levels in umbilical cord blood were 10.4 mu g/mL (IQR 6.4-14.9) and in peripheral blood were 4.7 mu g/mL (IQR 2.8-6.4 mu g/mL). Umbilical cord blood levels reached a peak approximately 30 min after IAP and then declined significantly (p < 0.001). Peripheral blood levels did not differ among study groups. Neonates exposed to a full loading dose (n= 115) had peripheral blood levels 2.5-70 times higher than the minimal inhibitory concentration for group B streptococcus. There was no relationship between neonatal ampicillin concentrations and the duration of IAP prior to delivery (beta=-0.0003, 95% CI -0.02 to 0.001, p = 0.680).Conclusions Ampicillin levels reach a peak in the umbilical cord blood within 30 min of intrapartum administration. After a full loading dose, bactericidal levels persist for at least 4 hours after birth and seem independent of the duration of IAP prior to delivery.