Antibiotics in the medical and surgical treatment of necrotizing enterocolitis. A systematic review

Abstract

Abstract Background The 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). Objective Identifying 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. Methods Embase, MEDLINE and Cochrane were searched systematically for human studies using antibiotics for patients with NEC, Bell’s stage II and III. Results Five 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. Conclusions 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.

Keywords

• Necrotizing enterocolitis
• Antibiotics
• Surgery
• Death