Two Antibiotics Are Not Better Than One for Gram-Negative Infections in Kids

Combination therapy with two antibiotics is not better than one and may be worse for children with gram-negative bacteremia. In a 10-year retrospective study, doctors found that combination therapy with a beta-lactam and an aminoglycoside had equivalent rates of mortality as the beta-lactam alone. However, the risk of nephrotoxicity was more than double when the two drugs were taken together.

The report was published online in JAMA Pediatrics by Pranita Tamma, MD, MHS, of the Johns Hopkins University School of Medicine in Baltimore, MD, and colleagues.

The study followed 870 pediatric patients with bacteremia; 537 (61.1 percent) received combination therapy. The two groups were well balanced demographically and clinically. There was no association between combination therapy and 30-day mortality (odds ratio [OR], 0.98; 95 percent Confidence Interval [CI], 0.93-1.02; P = .27).

A total of 170 patients (19.3 percent) had evidence of acute kidney injury, including 135 (25.1 percent) and 35 (10.2 percent) in the combination therapy and monotherapy arms, respectively. Patients who received the combination therapy had approximately twice the odds of nephrotoxicity compared with those receiving monotherapy (OR, 2.15; 95 percent CI, 2.09-2.21).

The beta-lactam used most often was piperacillin-tazobactam, followed by ceftriaxone and cefepime HCl.

The study concluded that using beta-lactam monotherapy for gram-negative bacteremia in pediatric patients reduces subsequent nephrotoxicity without compromising survival.