Facing Neonatal Stenotrophomonas Maltophilia Infection: Trimethoprim-Sulfamethoxazole or Levofloxacin?

Stenotrophomonas maltophilia, a multidrug-resistant gram-negative bacillus is an opportunistic organism. Infections caused by this pathogens needs to be treated promptly and is life-threatening in neonates (1, 2). The most common clinical presentations are pneumonia and bacteremia. Treatment includes limited number of antimicrobials with defined Minimum inhibitory concentration (MIC) cutoffs by US Clinical and Laboratory Standards Institute (CSLI). These include trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin, ticarcillin-clavulanate, minocycline, ceftazidime and chloramphenicol (1). Treatment of choice is TMP-SMX based on reliable in-vitro activity and favorable clinical outcomes (1, 2). Levofloxacin is a potential alternative to TMP-SMX (1). Usually we encounter high resistant rates to ceftazidime (3). Ticarcillin-clavulanate is not readily available in Iran. Also it is shown to be less active than TMP-SMX in vivo (2). One of the concerns with sulfa antibiotics in neonates is the potential risk of hyperbilirubinemia and kernicterus (2, 4-6). The landmark study was in 1956 in which Andersen et al elucidated that premature infants receiving a penicillin/sulfisoxazole combination had a significantly higher rate of mortality and kernicterus compared with oxytetracycline (4). In the study by Thyagarajan et al., suggested that the concept of kernicterus and TMP-SMX remains a theory and needs to be further illuminated in trials. Based on their experience, who prescribed TMPSMX for treatment of sepsis and pneumonia in newborns and infants in rural and tribal areas in India in a homebased neonatal care setting, no adverse effects, including any signs of central nervous system (CNS) toxicity was J Pharm Care 2019; 7(3):42-43.