NECROTIZING ENTEROCOLITIS Treatment

Antibiotics i. The goals are to prevent ongoing GI mucosal injury, prevent translocation of enteric bacteria into the bloodstream, and reduce mortality. ii. Common pathogens (a) Blood cultures are positive in only around 30% of neonates with NEC. (b) Enterobacteriaceae (e.g., E. coli, Klebsiella spp., and Enterobacter spp.) are the most common causative organisms. (c) Staphylococcus epidermidis, Enterococcus spp., Staphylococcus aureus, Clostridium perfringens, Pseudomonas aeruginosa, and Salmonella have also been isolated from neonates with NEC. iii. Possible regimens (a) There is no evidence to support the superiority of one regimen to the others. (1) Lack of well-designed studies evaluating antibiotic regimens for NEC (2) Most recent Cochrane review included only two trials from the 1980s that compared ampicillin plus gentamicin with the same regimen plus clindamycin or the same regimen plus enteral gentamicin. (b) Gram-positive coverage can be provided by ampicillin or vancomycin. (c) Gram-negative coverage can be provided by an aminoglycoside or a third-, or fourthgeneration cephalosporin. (d) Anaerobic coverage (e.g., clindamycin, metronidazole) is added if there is evidence of bowel perforation or peritonitis. Some institutions routinely add anaerobic coverage for all cases of NEC. Neonates randomized to receive ampicillin plus gentamicin and clindamycin had a statistically higher risk of strictures than those who received ampicillinplus gentamicin alone.(e) The specific antimicrobial agents used should be based on an individual unit’santibiogram.(f) Optimal duration is not known; in clinical practice, duration is generally based on Bell’sstaging.(1) Bell’s stage I – Often 48–72 hours, “rule out” NEC(2) Bell’s stage II

a – 7–10 days(3) Bell’s stages IIb and III – 10–14 days

#TreatmentEnterocolitis #antibiotics