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If you read Feigin & Cherry's text book of infectious disease or Oski's
textbook, late onset LISTERIA (usually meningitis) can occur upto 3 months
of age. Hence if you will remember, the usual treatment of infants prior to
the early 90's, was, inpatient management of all infants under 3 months
with a diagnosis of FWS, with AMP+Gent.
 
Subsequently, the studies by Baskin, O Rourke, Fleisher & then by Bonadio
in 1992-1993, that prospectively looked at selective outpatient management
of infants 28-90 days changed this practice. With the arrival of
Ceftriaxone and then the controversial "fever" guidelines, outpatient
management of the 4-12 week old  became quite common, especially if they
met "low risk" criteria.
 
Listeria as the offending organism, has never been discussed in the above
literature, as the age group for outpatient Mx was lowered. None of these
studies reported Listeria as a big offender in the 28-90 days age group
presenting as sepsis or as r/o sepsis/OB. My personal ancecdotal experience
shares this view.
 
I have dropped Ampicillin in the routine treatment of r/o sepsis after the
neonatal age group (>28 days) UNLESS they have meningitis. Listeria is very
much like late onset GBS disease and other bacterial causes of neonatal
meningitis. You have to cover for the neonatal bugs until 3 months of age
if they present with MENINGITIS.
 
BTW, germaine to all this discussion is the fact that Ampicillin is the
only penicillin that covers Listeria and is also synergistic with the
aminoglycosides in GBS dis or listeriosis.
 
Hope that helps.
 
Jay Pershad
"We care for wee folks"
----------
> From: Isaacman, Daniel M.D. <[log in to unmask]>
 
> One of our former chief residents just asked me a question that I'd like
to
> throw out for the group.  He was trained (not by me) to treat all
neonates
> with amp and cefotaximine (or ceftriaxone or gent) until 8 weeks of age.
> The question is when can the amp be dropped.  Various practitioners seem
to
> differ between 4 and 8 weeks of age. Does anyone have a cutpoint that
they
> use and a reference that substantiates that particular choice?  Thanks.
>
> Daniel J. Isaacman, M.D.
>
 
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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html