{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:40:47Z","timestamp":1781844047711,"version":"3.54.5"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>Ampicillin is frequently used in neonates for early- and late-onset group B streptococcal (GBS) disease. In 2019, the American Academy of Pediatrics (AAP) published guidelines for GBS which included updated dosing recommendations for ampicillin for bacteremia and provided specific dosing recommendations for meningitis. The dosing recommendations in the guidelines were based off the 2018 Report of the Committee on Infectious Diseases (i.e., Red Book), which differed from the 2015 Red Book. For bacteremia, no dosing changes were recommended for ampicillin dosing in neonates \u2264\u20097 days of postnatal age (PNA), but less frequent dosing intervals were recommended for neonates &gt;\u20097 days PNA. For meningitis, increased dosing recommendations were provided in the update. However, the rationale and supporting evidence for these changes were not provided. A literature search was performed to review articles pertaining to the pharmacokinetics (PK), pharmacodynamics (PD) and safety of ampicillin in neonates. The ampicillin dosing recommendations in the AAP guidelines were mainly supported by a 2014 publication that evaluated the PK and PD of ampicillin in neonates with gestational age (GA) of 24 to 41 weeks and PNA of 0 to 25 days. The proposed dosing from this study for bacteremia is included in the 2018 Red Book and 2019 guidelines. For meningitis, no supporting evidence was identified for the dosing recommendations in the 2018 Red Book and 2019 guidelines. Only one study has evaluated ampicillin concentrations in cerebrospinal fluid, but proposed dosing from this study was much lower than that included in the guidelines. The high ampicillin doses for GBS meningitis should be used with caution, as high ampicillin concentrations have been associated with seizures and no studies have evaluated efficacy of this dosing strategy. The purpose of this review is to identify key pieces of literature regarding dosing recommendations and safety of ampicillin in neonates.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1718880","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T22:58:17Z","timestamp":1603407497000},"page":"717-725","source":"Crossref","is-referenced-by-count":9,"title":["Ampicillin Dose for Early and Late-Onset Group B Streptococcal Disease in Neonates"],"prefix":"10.1055","volume":"39","author":[{"given":"Sin Yin","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Pharmacy Practice, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie L.","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Pharmacy Practice, Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"e20182896","DOI":"10.1542\/peds.2018-2896","article-title":"Management of neonates born at \u2264\u200934 6\/7 weeks' gestation with suspected or proven early-onset bacterial sepsis","volume":"142","author":"K M Puopolo","year":"2018","journal-title":"Pediatrics"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"e20182894","DOI":"10.1542\/peds.2018-2894","article-title":"Management of neonates born at >\u200935 0\/7 weeks\u2019 gestation with suspected or proven early-onset bacterial sepsis","volume":"142","author":"K M Puopolo","year":"2018","journal-title":"Pediatrics"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"e20162013","DOI":"10.1542\/peds.2016-2013","article-title":"Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014","volume":"138","author":"S J Schrag","year":"2016","journal-title":"Pediatrics"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1001\/jamapediatrics.2018.4826","article-title":"Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance","volume":"173","author":"S A Nanduri","year":"2019","journal-title":"JAMA Pediatr"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"e20191881","DOI":"10.1542\/peds.2019-1881","article-title":"Management of infants at risk for group B streptococcal disease","volume":"144","author":"K M Puopolo","year":"2019","journal-title":"Pediatrics"},{"key":"ref6","first-page":"915","volume-title":"Antibacterial drugs for neonates (<28 postnatal days of age)","author":"American Academy of Pediatrics","year":"2018","edition":"31st ed."},{"key":"ref7","volume-title":"2018 Nelson's Pediatric Antimicrobial Therapy","author":"American Academy of Pediatrics","year":"2018","edition":"24th ed."},{"issue":"07","key":"ref8","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"D Moher","year":"2009","journal-title":"PLoS Med"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1002\/phar.1916","article-title":"Population pharmacokinetics and pharmacodynamic target attainment of ampicillin in neonates with hypoxemic-ischemic encephalopathy in the setting of controlled hypothermia","volume":"37","author":"J J Cies","year":"2017","journal-title":"Pharmacotherapy"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"3013","DOI":"10.1128\/AAC.02374-13","article-title":"Characterization of the population pharmacokinetics of ampicillin in neonates using an opportunistic study design","volume":"58","author":"A Tremoulet","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"issue":"S 05","key":"ref11","doi-asserted-by":"crossref","first-page":"S518","DOI":"10.1093\/clinids\/8.Supplement_5.S518","article-title":"Pharmacokinetic study of sulbactam and ampicillin administered concomitantly by intraarterial or intravenous infusion in the newborn","volume":"8","author":"A M Sutton","year":"1986","journal-title":"Rev Infect Dis"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/BF00446070","article-title":"Serum levels of ampicillin and gentamycin in neonates of varying gestational 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Hermans","year":"1975","journal-title":"Arzneimittelforschung"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0022-3476(74)80684-0","article-title":"Pharmacologic studies in neonates given large dosages of ampicillin","volume":"84","author":"J M Kaplan","year":"1974","journal-title":"J Pediatr"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1542\/peds.39.1.97","article-title":"Clinical pharmacology of antimicrobials in premature infants. 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