Short course of intravenous antibiotics in the treatment of uncomplicated proven neonatal bacterial sepsis: A systematic review

Abstract

AimTo evaluate the efficacy and harms of a short (7–10 days) compared with a standard (10–14 days) duration of antibiotics in culture‐proven neonatal sepsis for reducing all‐cause mortality, treatment failure and duration of hospitalisation.MethodsMedline, EMBASE and Cochrane CENTRAL were searched for randomised trials.ResultsWe included five studies, all conducted in India (447 infants with a gestational age greater than 32 weeks). Except for one study, all studies were at high risk of bias. All‐cause mortality was reported in three studies with only one death reported in the standard duration regimen arm (243 patients, very low certainty). A meta‐analysis showed no evidence of the effect on treatment failure (RR of 1.47 [95% CI 0.48–4.50], 440 patients, five studies, very low certainty) of short‐term antibiotics. Short‐term antibiotic regimen shortened the duration of hospitalisation by 4 days (mean difference of −4.04 days [95% CI −5.47 to −2.61]; 4 studies; 371 patients; very low certainty).ConclusionAmong studies focused on infants born with a gestational age greater than 32 weeks, short‐term administration of antibiotics may shorten the duration of hospitalisation, but the evidence is very uncertain. The evidence on other predefined outcomes is very uncertain to draw definite conclusions.

Stop in Time: How to Reduce Unnecessary Antibiotics in Newborns with Late-Onset Sepsis in Neonatal Intensive Care

“…Furthermore, a long course of antibiotics changes the natural individual’s microbiome and may result in subsequent difficult-to-treat infections [ 78 ]. The shortest course of therapy is an option that should be explored; however, to date, few studies have examined the effectiveness of shorter antibiotic courses, and there is no consensus on the appropriate duration of antibiotic treatment for culture-proven uncomplicated neonatal sepsis [ 79 , 80 ].…”

“…A short duration of antibiotics was defined as receiving antibiotics targeting the isolated microorganism for equal to or more than 7–10 days, whereas the standard course refers to more than 10–14 days. Five randomized controlled trials, all conducted in India, included 51.6% of EOS episodes and 48.4% of LOS episodes in the short-duration arm [ 80 ].…”

“…Only three studies reported all-cause mortality within 28 days after discharge or completion of antibiotic treatment, with an odds ratio of 0.32 (95% CI 0.01–8.24) for a short course compared to a standard duration. The evidence was very low due to a high risk of bias across almost all studies [ 80 ].…”