From the Research
The most appropriate pharmacotherapy for this newborn is ampicillin and gentamicin (option A). This premature infant presents with jitteriness, hypothermia, and persistent hypoglycemia despite glucose administration, which are concerning for neonatal sepsis. The combination of ampicillin and gentamicin provides broad-spectrum coverage against common neonatal pathogens including Group B Streptococcus, Escherichia coli, and Listeria monocytogenes. Ampicillin covers gram-positive organisms and Listeria, while gentamicin targets gram-negative bacteria. This empiric antibiotic regimen is the standard of care for suspected early-onset neonatal sepsis, especially in a premature infant with risk factors including prematurity and prolonged rupture of membranes, as supported by the most recent study 1.
Key points to consider in this case include:
- The patient's symptoms and risk factors, which suggest a high likelihood of neonatal sepsis
- The importance of prompt initiation of empiric antibiotic therapy to prevent rapid progression and high mortality
- The need for blood, urine, and CSF cultures to guide adjustment of antibiotics based on culture results and clinical response
- The standard of care for suspected early-onset neonatal sepsis, which is the combination of ampicillin and gentamicin, as recommended by recent studies 1, 2
It is also important to note that while other antibiotics, such as ceftriaxone, cilastatin-imipenem, and erythromycin, may be effective against certain pathogens, they are not the first-line choice for empiric treatment of neonatal sepsis, as supported by studies 3, 4, 5.
In terms of pharmacokinetics, ampicillin and gentamicin have been studied in neonates, and their dosing and administration should be carefully considered to ensure effective treatment and minimize toxicity, as discussed in studies 3, 5.
Overall, the combination of ampicillin and gentamicin is the most appropriate pharmacotherapy for this newborn, given the clinical presentation and risk factors, and is supported by recent and high-quality evidence 1, 2.