From the Guidelines
Cephalexin can be given to neonates, but only for those older than 28 days, and the dosage should be 50-100 mg/kg per day in 4 doses, as recommended by the most recent guidelines 1. When considering the use of cephalexin in neonates, it's crucial to weigh the potential benefits against the risks, particularly in terms of morbidity, mortality, and quality of life. The evidence suggests that cephalexin is effective against a range of bacterial infections, including urinary tract infections and skin and soft tissue infections, which are common in neonates. Key considerations for the use of cephalexin in neonates include:
- Age: Cephalexin is recommended for neonates older than 28 days, as specified in the guidelines 1.
- Dosage: The recommended dosage is 50-100 mg/kg per day in 4 doses, which is consistent with the guidelines for older neonates 1.
- Monitoring: Careful monitoring for side effects, including gastrointestinal disturbances and allergic reactions, is essential when administering cephalexin to neonates.
- Alternative treatments: For serious neonatal infections, broader-spectrum antibiotics may be preferred initially until culture results are available, as noted in the guidelines 1. It's also important to consider the potential risks and benefits of cephalexin in the context of real-life clinical medicine, rather than relying solely on research or clinical trials. In this context, the guidelines provide a clear recommendation for the use of cephalexin in neonates older than 28 days, with careful monitoring and consideration of alternative treatments as needed.
From the Research
Cephalexin Use in Neonates
- There are no direct studies on the use of cephalexin in neonates, but some studies provide information on the use of cephalosporins in this population 2, 3.
- Ceftriaxone, a cephalosporin, is contraindicated in neonates due to its risk of biliary pseudolithiasis, but the data behind this contraindication is poor 2.
- Cephalexin is used for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections in children, and a population pharmacokinetic model has been developed to determine twice- and thrice-daily dosing regimens for MSSA infections in children 4.
- An older study evaluated the clinical and laboratory effectiveness of cephalexin in infants and children, but it does not specifically address neonates 5.
- Other studies discuss the use of alternative antibiotics, such as ceftazidime-avibactam, for the treatment of extensively drug-resistant or pan drug-resistant Klebsiella pneumoniae in neonates and children <5 years of age 6.
Considerations for Cephalexin Use
- The American Academy of Pediatrics has recommended ceftazidime as an alternative to cefotaxime, but it is inequivalent 2.
- Cefepime should be more frequently utilized in neonates who are poor candidates for ceftriaxone 2.
- The use of cephalosporins, such as cefotaxime, has been associated with an increased risk of neonatal death compared to the use of ampicillin and gentamicin 3.