Document Detail


Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis.
MedLine Citation:
PMID:  22895960     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although the exact aetiology of necrotising enterocolitis (NEC) remains unknown, research suggests that it is multifactorial; suspected pathophysiological mechanisms include immaturity, intestinal ischaemia, disruption of intestinal mucosal integrity, formula feeding, hyperosmolar load to the intestine, infection and bacterial translocation. Various antibiotic regimens have been widely used in the treatment of NEC.
OBJECTIVES: To compare the efficacy of different antibiotic regimens on mortality and the need for surgery in neonates with NEC.
SEARCH METHODS: Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2012), Oxford Database of Perinatal Trials, MEDLINE (1966 to February 2012), EMBASE (1980 to February 2012) and CINAHL (1982 to February 2012).
SELECTION CRITERIA: All randomised and quasi-randomised controlled trials where antibiotic regimens were used for treatment of NEC.
DATA COLLECTION AND ANALYSIS: Eligibility of studies for inclusion was assessed independently by each review author. The criteria and standard methods of the Cochrane Neonatal Review Group were used to assess the methodological quality of the included trials.
MAIN RESULTS: Two trials met the inclusion criteria. Faix 1988 randomised 42 premature infants with radiological diagnosis of NEC. Infants were randomised to receive either intravenous ampicillin and gentamicin or ampicillin, gentamicin and clindamycin. Hansen 1980 randomised 20 infants with NEC to receive intravenous ampicillin and gentamicin with or without enteral gentamicin.In the study by Faix 1988, there were no statistical differences in mortality (RR 1.10; 95% CI 0.32 to 3.83) or bowel perforation (RR 2.20; 95% CI 0.45 to 10.74) between the two groups although there was a trend towards higher rate of strictures in the group that received clindamycin (RR 7.20; 95% CI 0.97 to 53.36).The Hansen 1980 study showed no statistically significant difference in death, bowel perforation or development of strictures.
AUTHORS' CONCLUSIONS: There was insufficient evidence to recommend a particular antibiotic regimen for the treatment of NEC. There were concerns about adverse effects following the usage of clindamycin, related to the development of strictures. To address this issue a large randomised controlled trial needs to be performed.
Authors:
Dharmesh Shah; John K H Sinn
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Review     Date:  2012-08-15
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  8     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-16     Completed Date:  2012-09-26     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD007448     Citation Subset:  IM    
Affiliation:
Neonatal Intensive Care Unit, Westmead Hospital, Sydney, Australia. dharmeshparul@yahoo.com.
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MeSH Terms
Descriptor/Qualifier:
Ampicillin / therapeutic use
Anti-Bacterial Agents / therapeutic use*
Clindamycin / therapeutic use
Drug Therapy, Combination / methods
Enterocolitis, Necrotizing / drug therapy*,  mortality
Gentamicins / therapeutic use
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / drug therapy*,  mortality
Intestinal Perforation / prevention & control
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Gentamicins; 18323-44-9/Clindamycin; 69-53-4/Ampicillin

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