Jessica E Ericson1, Christoph P Hornik2,3, Rachel G Greenberg2,3, Reese H Clark4, Adriana H Tremoulet5, Jennifer Le6, Michael Cohen-Wolkowiez2,3, P Brian Smith2,3, Daniel K Benjamin2,3. 1. From the Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania. 2. Department of Pediatrics, Duke University, Durham, North Carolina. 3. Duke Clinical Research Institute, Duke University, Durham, North Carolina. 4. Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida. 5. Department of Pediatrics, University of California, San Diego, La Jolla, California. 6. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, La Jolla, California.
Abstract
BACKGROUND: High doses of ampicillin are often used to achieve therapeutic drug concentrations in infants. A paradoxical antibiotic effect, often called the Eagle effect, occurs when increasing concentrations of antibiotic above a threshold results in decreased efficacy. It is unknown if infants treated with ampicillin are at risk for this paradoxical effect. METHODS: We identified infants <28 days of age with Escherichia coli, Enterococcus or Streptococcus agalactiae (group B streptococcus) bloodstream infections from 1997 to 2012 and previously included in an ampicillin pharmacokinetic (PK) modeling study. We compared the odds of death for ampicillin dose, estimated time above the minimum inhibitory concentration (T > MIC) and PK parameters using separate logistic regression models. Adjusted logistic regression and Poisson models were used to calculate the odds of prolonged bacteremia ≥3 days and the duration of bacteremia, respectively, for dose, T > MIC and multiple PK parameters. RESULTS: Among 1272 infants meeting inclusion criteria, odds of death 7 or 30 days after the positive blood culture were not consistent with a paradoxical effect across any of the dosing regimens or PK parameters evaluated. The odds of prolonged bacteremia was lowest at the lowest dose category and the lowest daily dose category but not associated with the area-under-the-concentration time curve from 0 to 24 hours, or the maximum or minimum concentrations at steady state. T > MIC of ≥50% of the dosing interval was associated with decreased duration of bacteremia and odds of prolonged bacteremia. CONCLUSIONS: It is unlikely that a paradoxical antibiotic effect will have a clinical correlate when ampicillin is used for neonatal bacteremia. A T > MIC ≥50% decreased both duration of bacteremia and odds of prolonged bacteremia.
BACKGROUND: High doses of ampicillin are often used to achieve therapeutic drug concentrations in infants. A paradoxical antibiotic effect, often called the Eagle effect, occurs when increasing concentrations of antibiotic above a threshold results in decreased efficacy. It is unknown if infants treated with ampicillin are at risk for this paradoxical effect. METHODS: We identified infants <28 days of age with Escherichia coli, Enterococcus or Streptococcus agalactiae (group B streptococcus) bloodstream infections from 1997 to 2012 and previously included in an ampicillin pharmacokinetic (PK) modeling study. We compared the odds of death for ampicillin dose, estimated time above the minimum inhibitory concentration (T > MIC) and PK parameters using separate logistic regression models. Adjusted logistic regression and Poisson models were used to calculate the odds of prolonged bacteremia ≥3 days and the duration of bacteremia, respectively, for dose, T > MIC and multiple PK parameters. RESULTS: Among 1272 infants meeting inclusion criteria, odds of death 7 or 30 days after the positive blood culture were not consistent with a paradoxical effect across any of the dosing regimens or PK parameters evaluated. The odds of prolonged bacteremia was lowest at the lowest dose category and the lowest daily dose category but not associated with the area-under-the-concentration time curve from 0 to 24 hours, or the maximum or minimum concentrations at steady state. T > MIC of ≥50% of the dosing interval was associated with decreased duration of bacteremia and odds of prolonged bacteremia. CONCLUSIONS: It is unlikely that a paradoxical antibiotic effect will have a clinical correlate when ampicillin is used for neonatal bacteremia. A T > MIC ≥50% decreased both duration of bacteremia and odds of prolonged bacteremia.
Authors: Antonio Benjumea; Marta Díaz-Navarro; Rama Hafian; Mar Sánchez-Somolinos; Javier Vaquero; Francisco Chana; Patricia Muñoz; María Guembe Journal: Microbiol Spectr Date: 2022-02-16
Authors: Ronaldo Morales Junior; Gabriela Otofuji Pereira; Gustavo Magno Baldin Tiguman; Vanessa D'Amaro Juodinis; João Paulo Telles; Daniela Carla de Souza; Silvia Regina Cavani Jorge Santos Journal: Front Pediatr Date: 2022-03-10 Impact factor: 3.418