Another risk in the early introduction of antibiotics in infants is the increase in the development of antibiotic-resistant strains of infectious disease. Current methods of treatment for EOS are often implemented before a positive sepsis blood culture is found. In the last two decades (2000-2020), the use of intrapartum antibiotics has reduced the incidence of EOS. The current challenge faced by clinicians is mainly weighing the risk and benefits of the possibility of antibiotic overtreatment vs. the effects of sepsis. Epidemiology
Since the 1990s early-onset sepsis has declined because of screening of group B streptococcus. The cause of early-onset neonatal sepsis are pathogens that contaminate the placenta, vaginal canal, cervix, or amniotic fluid, and these pathogens can affect the baby either in the womb or during labor. Early-onset neonatal sepsis is found to be 0.77 to 1 per 100,000 live births in the U.S. In premature babies, the incidence and mortality rates are higher due to the weakness of their immune system. For infants with low birth weight, cases of early-onset sepsis is found to be about 26 per 1,000 and 8 per 1,000 live births. Certain populations of babies are at more risk as well. Mothers who have poor healthcare, low socioeconomic status, substance abuse, or are African American have higher rates of neonatal sepsis. In fact, African American preterm babies have the highest rate of infection and mortality. 5.14 of every 1,000 live births and 24.4% case fatality ratio, respectively.
Alitretinoin, or 9-cis-retinoic acid, is a form of vitamin A. It is also used in medicine as an antineoplastic (anti-cancer) agent developed by Ligand Pharmaceuticals. It is a first generation retinoid. Ligand gained Food and Drug Administration (FDA) approval for alitretinoin in February 1999. Medical uses
Kaposi’s sarcoma
In the United States, topical alitretinoin is indicated for the treatment of skin lesions in AIDS-related Kaposis sarcoma. Alitretinoin is not indicated when systemic therapy against Kaposis sarcoma is required. It has received EMA (11 October 2000) and FDA (2 March 1999) approval for this indication. Chronic hand eczema
Alitretinoin has been granted prescription rights in the UK (08/09/2008) for in chronic hand eczema as used by mouth. In May 2009 the National Institute for Health and Clinical Excellence (NICE) issued preliminary guidance on the use of alitretinoin for the treatment of severe chronic hand eczema in adults. The recommendation stated that only patients with severe chronic hand eczema who are unresponsive to potent topical corticosteroids, oral immunosuppressants or phototherapy should receive the drug. Final NICE guidance is expected in August 2009. Adverse effects
Systemic use
Very common (>10% frequency):

Headache
Hypertriglyceridemia
High density lipoprotein decreased
HypercholesterolemiaCommon (1-10% frequency):

Uncommon (0.1-1% frequency):

Rare (<0.1% frequency):

Benign intracranial hypertension
VasculitisUnknown frequency:

Topical use
Very common (>10% frequency):

Rash (77%)
Pain (34%)
Itchiness (11%)Common (1-10% frequency):

Exfoliative dermatitis
Oedema
Skin changes
Paraesthesia

Contraindications
Pregnancy is an absolute contraindication as with most other vitamin A products, it should also be avoided when it comes to systemic use in any women that is of childbearing potential and not taking precautions to prevent pregnancy. Toctino (the oral capsule formulation of alitretinoin) contains soya oil and sorbitol.