Efficacy and Safety of Oral Neomycin for the Decolonization of Carbapenem-Resistant Enterobacterales: An Open-Label Randomized Controlled Trial
Issued Date
2024-08-01
Resource Type
eISSN
20796382
Scopus ID
2-s2.0-85202623188
Journal Title
Antibiotics
Volume
13
Issue
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
Antibiotics Vol.13 No.8 (2024)
Suggested Citation
Tancharoen L., Srisomnuek A., Tiengrim S., Thamthaweechok N., Tangkorskul T., Thamlikitkul V. Efficacy and Safety of Oral Neomycin for the Decolonization of Carbapenem-Resistant Enterobacterales: An Open-Label Randomized Controlled Trial. Antibiotics Vol.13 No.8 (2024). doi:10.3390/antibiotics13080781 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/100941
Title
Efficacy and Safety of Oral Neomycin for the Decolonization of Carbapenem-Resistant Enterobacterales: An Open-Label Randomized Controlled Trial
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Abstract
Background: Patients with carbapenem-resistant Enterobacterales (CRE) in the gastrointestinal (GI) tract are at risk for subsequent infections and transmission, necessitating contact precautions. Neomycin has shown in vitro activity against CRE in 66–85% of isolates. This study evaluated the efficacy and safety of neomycin for CRE decolonization. Methods: In this open-label randomized controlled trial, stool/rectal swab samples from high-risk patients were collected and tested for CRE colonization in the GI tract. Patients who had CRE and met eligible criteria were divided into a neomycin group (n = 26; treated with 4.2 g/day neomycin for 5 days) and a control group (n = 26). CRE detection in stool/rectal swabs was performed on days 7 ± 2 and 14 ± 2. Results: The two groups’ baseline characteristics were similar. CRE presence on day 7 ± 2 was significantly lower in the neomycin group (46.2%) than in the control group (80.8%, p = 0.01). Efficacy of neomycin (4.2 g/day for 5 days) for CRE decolonization was 42.8–53.8% by day 7. By day 14 ± 2, the CRE rate in the neomycin group had risen to align with the control group’s rate (73.1% vs. 61.5%, p = 0.56). The neomycin group experienced mild, temporary, gastrointestinal side-effects. Conclusions: Neomycin effectively reduced CRE colonization on day 7 ± 2, but its impact waned by day 14 ± 2. This suggests that neomycin dosage was too low and the duration of treatment was too short for lasting CRE decolonization.