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Antibiotics in Neonates

By

Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Last full review/revision Jul 2020| Content last modified Jul 2020
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In neonates, the extracellular fluid (ECF) constitutes up to 45% of total body weight, requiring relatively larger doses of certain antibiotics (eg, aminoglycosides) compared with adults. Lower serum albumin concentrations in premature infants Premature Infants An infant born before 37 weeks gestation is considered premature. Prematurity is defined by the gestational age at which infants are born. Previously, any infant weighing read more may reduce antibiotic protein binding. Drugs that displace bilirubin from albumin (eg, sulfonamides, ceftriaxone) increase the risk of kernicterus Kernicterus Kernicterus is brain damage caused by unconjugated bilirubin deposition in basal ganglia and brain stem nuclei. Normally, bilirubin bound to serum albumin stays in the intravascular space. However... read more .

Absence or deficiency of certain enzymes in neonates may prolong the half-life of certain antibiotics (eg, chloramphenicol) and increase the risk of toxicity. Changes in glomerular filtration rate and renal tubular secretion during the first month of life necessitate dosing changes for renally excreted drugs (eg, penicillins, aminoglycosides, vancomycin).

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