ArticlePediatric research2026
Outcomes of early-phase ampicillin plus aminoglycosides versus ampicillin plus cefotaxime for preterm infants.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhen used as early empirical antibiotics for preterm infants, ampicillin + aminoglycosides may reduce mortality more effectively than ampicillin + cefotaxime. We compared in-hospital outcomes between early-phase ampicillin + aminoglycoside and ampicillin + cefotaxime therapy.
methodsPreterm infants (<35 weeks' gestation) hospitalized between July 2010 and March 2022 were identified from a nationwide Japanese database. Patients received ampicillin + aminoglycoside (n = 33,204) or ampicillin + cefotaxime (n = 12,158) as early empirical therapy. We performed 2:1 propensity score-matched analysis to compare in-hospital mortality and major morbidities. Subgroup analyses were performed for infants <28 weeks' gestation.
resultsAfter 2:1 propensity score matching, mortality (2.6% vs. 2.5%; p = 0.55) and hearing impairment incidence (0.63% vs. 0.60%; p = 0.71) were similar between groups; however, among infants born at <28 weeks' gestation, hearing impairment was lower in ampicillin + aminoglycoside recipients (0.53% vs. 0.98%; p = 0.018). Ampicillin + aminoglycoside users had a lower incidence of bronchopulmonary dysplasia (21% vs. 23%, p < 0.001), retinopathy of prematurity (6.8% vs. 8.2%, p < 0.001), and hospitalization costs (USD 25,481 vs. 28,184, p < 0.001) than ampicillin + cefotaxime users.
conclusionEarly empirical ampicillin + aminoglycoside and ampicillin + cefotaxime therapy showed similar mortality in preterm infants. Antibiotic selection should consider resistance patterns and regimen-specific morbidities. IMPACT: Early-phase ampicillin + aminoglycoside administration in preterm infants possibly decreases mortality and morbidities (e.g., bacteremia) compared with ampicillin + cefotaxime administration. This large-scale, retrospective nationwide study enrolling 45,362 preterm infants revealed that early-phase antibiotic regimens (ampicillin + aminoglycosides/ampicillin + cefotaxime) did not affect in-hospital mortality. Ampicillin + aminoglycosides correlated with home assistive technology use, and ampicillin + cefotaxime with bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, and expensive hospitalization. The choice of early-phase antibiotics in preterm infants should be rooted in antimicrobial resistance patterns, considering the differences in morbidities between the two regimens.
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