Antibiotics in the Medical and Surgical Treatment of Necrotizing Enterocolitis. What Regimen is the Best? - A Systematic Review

Abstract

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.