Antibiotics in the medical and surgical treatment of necrotizing enterocolitis. 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 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.

Core-, pan- and accessory genome analyses of Clostridium neonatale: insights into genetic diversity

“…NEC treatment includes the use of broad-spectrum antibiotics, among which are clindamycin or metronidazole that target anaerobic bacteria [48]. Although one study has reported a significant association between C. butyricum-linked NEC and antibiotic administration [48], there are no data regarding the antimicrobial susceptibility of C. neonatale clinical isolates. Our data support the need, in future studies, to evaluate C. neonatale susceptibility to antibiotics.…”

“…Additionally, in strain NEC86, we identified in silico a gene encoding a 23S rRNA methyltransferase ermQ gene described to provide resistance to macrolides. NEC treatment includes the use of broad-spectrum antibiotics, among which are clindamycin or metronidazole that target anaerobic bacteria [48]. Although one study has reported a significant association between C. butyricum-linked NEC and antibiotic administration [48], there are no data regarding the antimicrobial susceptibility of C. neonatale clinical isolates.…”

“…Of the nine genomes studied, six had the Type I-B system and different types of CRISPR repeats and spacer contents. The strain CC3_PB and LF22 genomes were characterized by a higher number of spacers, which has been associated with greater genetic diversity of infecting phages [ 47 ]. Together, the identification of multiple mobile elements carrying unique and a large number of unknown function genes associated with different defensive mechanisms against foreign DNA support the horizontal gene transfer, genome organization differences and plasticity of the C. neonatale genome.…”

Neonatal antibiotics have long term sex‐dependent effects on the enteric nervous system

“…Pre‐term and low birth weight infants are frequently given antibiotics, but these treatment practices and types of antibiotics administered are dependent on the severity of their clinical symptoms and are highly variable (Gill et al., 2022 ; Sadeghirad et al., 2018 ). Our experimental model tests vancomycin, which is one of the antibiotics given to infants to prevent and treat diseases such as necrotising enterocolitis.…”

Neonatal complicated intraabdominal infection

“…There was no significant difference between the three regimens [28]. Other meta-analyses have confirmed that there is not enough evidence on the type of antibiotics, route of administration or duration of treatment [29 ▪▪ ,30]. The NICU Antibiotics and Outcomes (NANO) trial is an ongoing trial looking at empiric antibiotics (ampicillin and gentamicin) to determine if the rate of NEC is changed when compared with placebo treatment in ELBW infants [31].…”