Ampicillin and gentamicin in the treatment of fetal intrauterine infections

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Abstract
The optimum clinical results in the treatment of fetal intrauterine infections are obtained by the administration of the appropriate antibiotic, which reaches an adequate concentration in the fetal serum. The pharmacokinetics of ampicillin and gentamicin were studied in 60 pregnant women. Ampicillin and gentamicin were given i.m. prior to cesarean section. At delivery maternal serum, amniotic fluid and cord serum antibiotic levels were tested. Assays of the levels of antibiotic were performed by agar diffusion method using Staphylococcus aureus A.C.T.C. 25923 (American Type Control Collection) and Escherichia coli N.C.T.C 1346, as standard organisms. During peak time, concentration of ampicillin in the maternal serum was significantly higher than those of the amniotic fluid and cord serum (P < 0.001). Peak levels of the antibiotic in the amniotic fluid was also significantly higher than in the cord serum (P < 0.001). The determined levels of ampicillin, especially during peak time, are sufficient to inhibit in vitro a high proportion of infecting pathogens in the maternal serum and amniotic fluid, but have little effect against organisms in the fetal serum. Concentration of gentamicin in the maternal serum during peak time was higher than those of the amniotic fluid, but there was not a significant difference. Maternal serum peak levels of the drug were also higher than in cord serum, with a very significant difference (P < 0.001). Maximum levels of gentamicin in amniotic fluid were higher than in cord serum, also with a very significant difference (P < 0.001). Gentamicin levels in amniotic fluid and fetal serum especially during peak time would be adequate to inhibit in vitro the most common pathogens, sensitive to the drug.

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