Comparison of two antibiotic regimens for neonatal necrotizing enterocolitis

Treatment of neonatal necrotizing enterocolitis (NEC) regularly includes broadspectrum antibiotics but there has been no comparative study of alternative regimens. We have studied 90 infants with definite NEC; 46 cases in 1982–3 were treated with ampicillin and gentamicin, while 44 cases in 1984–5 received cefotaxime and vancomycin. Groups were well matched and managed uniformly. Infants ≥2200 g birthweight did well with either regimen. Smaller infants given cefotaxime and vancomycin had a lower risk of culture-positive peritonitis (P=0.01), and as a result, were less likely to die (P=0.048) or develop thrombocytopenia (P = 0.004). The better outcome might be explained by the greater suppression by cefotaxime and vancomycin of the gut flora of treated patients (P < 0.001). Both regimens were well-tolerated. Our data suggest that carefully chosen antibiotic regimens can improve the outcome of NEC.