title: A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis. Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants Oral gentamicin therapy in the prevention of neonatal necrotizing enterocolitis. A controlled double-blind trial. Enterobacteriaceae and neonatal necrotising enterocolitis. Necrotizing enterocolitis prophylaxis: oral antibiotics and lyophilized enterobacteria vs oral immunoglobulins Alterations in stool flora resulting from oral kanamycin prophylaxis of necrotizing enterocolitis. A randomized, controlled trial of parenteral clindamycin in neonatal necrotizing enterocolitis.
abstract: Alimentary kanamycin , 15 mg/kg/day , was given as prophylaxis for  neonatal necrotizing enterocolitis  in a prospect i ve study . Newborn infants of less than 1,500 gm birth weight who survived until initiation of alimentary nutrition at the University of Florida Neonatal Intensive Care Unit were admitted to a control or study group based on the last digit of the hospital number .  Alimentary kanamycin was not absorbed ; all blood levels determined were less than 0.5 μg/ml . The two groups had similar gestational ages , birth weights , severity of neonatal illness , and frequency of therapeutic procedures . In the study group of 35 infants , none developed neonatal necrotizing enterocolitis , whereas five cases occurred in the 40 control infants ( p=0.038 ) AIMS To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis  in preterm , very low birthweight infants . METHODS A prospect i ve , double blind , r and omised , placebo controlled study in a tertiary referral centre of a university teaching hospital was conducted on 140 very low birthweight infants consecutively admitted to the neonatal unit . The babies were r and omly allocated to receive oral vancomycin ( 15 mg/kg every 8 hours for 7 days ) or an equivalent volume of placebo solution . Prophylaxis was started 24 hours before the start of oral feeds . All suspected cases of necrotising enterocolitis were investigated with a full sepsis screen and serial abdominal radiographs . Necrotising enterocolitis was diagnosed and staged according to modified Bell ’s criteria . RESULTS Nine of 71 infants receiving oral vancomycin and 19 of 69 infants receiving the placebo solution developed necrotising enterocolitis ( p=0.035 ) . Infants with necrotising enterocolitis were associated with a significant increase in mortality ( p=0.026 ) and longer duration of hospital stay ( p = 0.002 ) . CONCLUSIONS Prophylactic oral vancomycin conferred protection against necrotising enterocolitis in preterm , very low birthweight infants and was associated with a 50 % reduction in the incidence . However , widespread implementation of this preventive measure is not recommended , as it would only be effective in necrotising enterocolitis caused by Gram positive organisms and could increase the danger of the emergence of vancomycin resistant or dependent organisms . Its use should be restricted to a high prevalence nursery for a short and well defined period in a selected group of high risk patients The value of prophylactic oral gentamicin sulfate therapy in the prevention of necrotizing enterocolitis ( NEC ) was evaluated in a group of 42 high-risk neonates over a four-month period in a r and omized , double-blind controlled trial . Twenty babies in the treatment group received 2.5 mg/kg of gentamicin sulfate every six hours for one week after birth , and 22 babies received dextrose- and -water placebo in an equivalently small volume . None of the 20 gentamicin-treated babies developed NEC . Four of the control babies did . Two of these babies died , and their diagnosis was pathologically confirmed . This difference in the incidence of NEC between the treatment and control group was significant at the .05 level . These results support the prophylactic use of orally given gentamicin for selected babies at high risk for NEC  , particularly those born prematurely and those who have a history of perinatal asphyxia or umbilical artery catheterization or both . Continued surveillance for changes in antimicrobial sensitivity patterns is recommended A comparative study of bowel colonisation and incidence of necrotising enterocolitis in neonates admitted to an intensive care unit is reported . Neonates of less than 33 weeks gestational age requiring mechanical ventilation for respiratory distress syndrome were r and omised during the first week of life to receive either vancomycin and aztreonam or vancomycin and gentamicin for episodes of suspected sepsis after the first week of life . A higher proportion of neonates who received vancomycin and gentamicin had faecal colonisation with enterobacteriaceae at the end of the second , third , and fourth weeks of life . Treatment with vancomycin and aztreonam was associated with a rapid quantitative reduction in faecal colonisation with enterobacteriaceae , whereas there was no quantitative reduction in colonisation with enterobacteriaceae associated with treatment with vancomycin and gentamicin . There were no differences between the two groups in faecal colonisation with anaerobes , Enterococcus sp , Staphylococcus sp , or yeasts . Six ( 14.6 % ) of 41 who received vancomycin and gentamicin compared with 0 of 40 who received vancomycin and aztreonam subsequently developed necrotising enterocolitis We conducted a prospect i ve r and omized trial to compare the efficacy of oral gentamicin versus oral IgA‐IgG for the prophylaxis of necrotizing enterocolitis ( NEC ) ;  200 newborns considered at high risk for NEC were assigned to group A ( oral IgA‐IgG , n= 100 ) or group B ( oral Gentamicin , n= 100 ) . NEC was diagnosed in 13 cases in group A and in 1 case in group B between the 3rd and 16th days of life . Surgical treatment was necessary in 3 cases ( 2 in group A ) . All infants survived . We conclude that oral gentamicin is more effective than oral IgA‐IgG in the prevention of NEC in infants at high risk To evaluate the effects of oral kanamycin prophylaxis for  necrotizing enterocolitis  on stool flora , 99 high-risk infants were studied on a double-blind basis during the first month of life . Oral kanamycin prophylaxis result ed in a significant decrase in gram-negative enteric colonization on Days 3 to 5 , 10 , 17 , and 24 compared to control infants ( P P P = 0.2 ) . The data indicate that oral kanamycin prophylaxis significantly reduces the colonization rate and overgrowth of gram-negative enteric flora , but does not eliminate the occurrence of NEC in a high-risk group of infants For an assessment of the efficacy of clindamycin in preventing bowel necrosis ( intestinal gangrene or perforation ) , 42 premature infants with radiographically confirmed necrotizing enterocolitis ( NEC ) ( pneumatosis , intraportal gas , or both ) were r and omly assigned to receive parenterally either ampicillin and gentamicin ( control group , n = 22 ) or ampicillin , gentamicin , and clindamycin ( n = 20 ) , 20 mg/kg/d at 8-hour intervals for 10 to 14 days . Infants who had received antibiotics for greater than 24 hours before r and omization and those developing intestinal gangrene or perforation less than 12 hours after r and omization were excluded .  Intestinal gangrene or perforation developed in four infants in the control group and six in the clindamycin group . Four in each group died of NEC . In the control group , one of 18 survivors developed a late stricture requiring surgical resection , whereas six of 15 survivors in the clindamycin group developed such strictures ( P = 0.022 ) . Routine inclusion of clindamycin in medical treatment of NEC does not reduce the frequency of intestinal gangrene or perforation and may be associated with an increase in late stricture formation
target: REVIEW ER 'S CONCLUSIONS Evidence suggests that oral antibiotics reduce the incidence of NEC in low birth weight infants .
background: BACKGROUND Necrotizing enterocolitis continues to be a problem , particularly in preterm neonates .
  There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis .
  This systematic review was undertaken to clarify the issue .
  OBJECTIVES To evaluate the benefits and harms of enteral antibiotic prophylaxis for  necrotizing enterocolitis in low birth weight and preterm infants .