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of mis-interpretation”  \nWen-Yin Chen, Miao-Chiu Hung  \nDivision of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC  \nDEAR EDITOR,  \nWe thank Dr. Szu-Ting Yang for the valuable comments1 and questions on our study named “Increased antibiotic exposure in early life is associated with adverse outcomes in very low birth weight infants” published in Journal of the Chinese Medical Association in June 2022.2 The author comments are discussed later.  \nFirst, the patients included into the analyses all received empiric treatment, since those with microbiologically confirmed infection were excluded. Therefore, the selection of antibiotics was based on patients’ clinical conditions (i.e., ampicillin and cefotaxime for those less severe, and teicoplaninand meropenem for ill-appearing infants) . We were aware that the differences in the antibiotics may have an impact on the outcomes. For example, based on our hypothesis, the broader spectrum the antibiotics have, the more likely they alter the microbiota and hence the outcomes. However, we found it difficult to separate the different antibiotics orderly into the  \nanalyses. For example, it was not always the combinations of teicoplanin and meropenem. Sometimes teicoplanin was changed to vancomycin to pursue higher central nervus system concentration. We had recorded all the antibiotic treatment of all the patients, including the type and length of each antibiotic. But given the small size of our study cohort, we found it difficult to analyze the data properly. Perhaps in the future with larger cohort size, we will be able to analyze the impacts of different kinds of antibiotics.  \nWe hope these explanations will suffice the readers’ and the authors’ expectations. Thanks for your kind comments again.  \nREFERENCES  \n1. Chang WH, Yang ST. Antibiotics use and worse outcome: A possibility of mis-interpretation. J Chin Med Assoc 2022;85:1163 .  \n2. Chen WY, Lo YC, Huang PH, ChenYX, Tsao PC, Lee YS, et al. Increased antibiotic exposure in early life is associated with adverse outcomes in very low birth weight infants. J Chin Med Assoc 2022;85:939–43 .  \n* Address correspondence. Dr. Miao-Chiu Hung, Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: mchung@vghtpe.gov.tw](ROC. E-mail address: mchung@vghtpe.gov.tw)[ ](ROC. E-mail address: mchung@vghtpe.gov.tw)(M.-C. Hung).  \nConflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2022) 85: 1164.  \nReceived October 4, 2022; accepted October 5, 2022.  \ndoi: 10. 1097/JCMA.0000000000000829.  \nCopyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \n1164 [www.ejcma.org](www.ejcma.org)  \n\u003Czdoi: 10.1097/JCMA.0000000000000829>","cbCaicAagwnvDhYY","https://ap.wps.com/l/cbCaicAagwnvDhYY","pdf",280024,"English","# Letter to the editor\n## Reply rationale and antibiotic selection\n## Future study considerations and closing","[{\"question\":\"Why did the authors include empiric-treatment patients in their analyses?\",\"answer\":\"All analyzed patients received empiric treatment, and those with microbiologically confirmed infection were excluded, so the antibiotic choice reflected each patient’s clinical condition.\"},{\"question\":\"What challenge prevented the authors from separating effects of different antibiotics?\",\"answer\":\"The study cohort was small, and antibiotic regimens were not consistently limited to single ordered combinations, making proper data analysis difficult.\"},{\"question\":\"How do the authors suggest future research should proceed?\",\"answer\":\"With a larger cohort, the authors expect to analyze the impacts of different types of antibiotics more appropriately.\"}]","Reply to: “Antibiotics use and worse outcome: A possibility of mis-interpretation” | PDF",1790677883]