Abstract
BackgroundThe aim of this review was to identify relevant randomized controlled trials (RCTs) and non-RCTs to evaluate the existing knowledge on the effect of antibiotic treatment for infants with necrotizing enterocolitis (NEC).ObjectiveIdentifying 1) the best antibiotic regimen to avoid disease progression as assessed by surgery or death, 2) the best antibiotic regimen for infants operated for NEC as assessed by re-operation or death.MethodsEmbase, MEDLINE and Cochrane were searched systematically for human studies using antibiotics for patients with NEC, Bell’s stage II and III.ResultsFive studies were included, with a total of 375 infants. There were 2 RCT and 3 cohort studies. Four main antibiotic regimens appeared. Three with a combination of ampicillin + gentamycin (or similar) with an addition of 1) clindamycin 2) metronidazole or 3) enteral administration of gentamycin. One studied investigated cefotaxime + vancomycin. None of the included studies had a specific regimen for infants undergoing surgery.ConclusionsNo sufficient evidence was found for any recommendation on the choice of antibiotics, the route of administration or the duration in infants treated for NEC with Bell’s stage II and III.
Highlights
The aim of this review was to identify relevant randomized controlled trials (RCTs) and non-Randomized controlled trial (RCT) to evaluate the existing knowledge on the effect of antibiotic treatment for infants with necrotizing enterocolitis (NEC)
No sufficient evidence was found for any recommendation on the choice of antibiotics, the route of administration or the duration in infants treated for NEC with Bell’s stage II and III
Backgound Estimated 1–3 of every 1000 newborns are affected by Necrotizing Enterocolitis (NEC) [1]
Summary
MEDLINE and Cochrane were searched systematically for human studies using antibiotics for patients with NEC, Bell’s stage II and III. Eligibility criteria Studies with documented NEC according to Bell’s classification stage II or III, treatment with at least one type of antibiotic and with reported progression of the disease defined as surgery and/or death as an outcome were included. Exclusion criteria were 1) inability to obtain the full text and insufficient data on primary outcomes, 2) studies with overlapping data, 3) case reports 4) nonoriginal articles such as reviews 5) articles not available in English or Scandinavian languages (Danish, Norwegian or Swedish). Clinicaltrials.gov and Prospero were searched for any relevant ongoing trials or reviews. 1980 RCTRandomization from number table Blinded intervention Faix [21]. 1988 RCTRandomization by sealed envelopes Unclear information about blinding Cohorte studies
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