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.

Background: The aim of this review was to identify relevant randomized controlled trials (RCTs) and non-RCTs to evaluate the existing knowledge on antibiotic treatment effect for infants with Necrotizing Enterocolitis (NEC). Objective: Identifying 1) the best antibiotic regimen to avoid progression or surgery in infants with NEC 2) the best antibiotic regimen for infants operated for stage III NEC. Methods: Embase, MEDLINE and Cochrane were searched systematically for human studies using antibiotics for patients with NEC. Eligible studies had patients with NEC Bells stage II and III. Study selection, data extraction, and quality assessment were performed independently by two authors. RoB2 and ROBINS-I were used where appropriate. Results: 5 studies were included, 2 RCT and 3 n-RCT. Four regimens were investigated. Three used a combination of ampicillin + gentamycin (or similar) with an addition of 1) clindamycin 2) metronidazole or 3) enteral gentamycin. One studied investigated cefotaxime + vancomycin. None of the included studies had a specific regimen for stage III infants undergoing surgery. Conclusions: A GRADE evaluation was not possible because of large heterogeneity. For now, there is not sufficient evidence to make a general recommendation on which antibiotic regimen is the most effective for infants with NEC stage II and III.

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