Efficacy and safety of short- vs. standard-course antibiotics for culture-negative neonatal sepsis: a systematic review and meta-analysis.

Autor:	Devi R; Department of Neonatology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India., Priyadarshi M; Department of Neonatology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India., Singh P; Department of Neonatology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India., Chaurasia S; Department of Neonatology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India., Basu S; Department of Neonatology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India.
Jazyk:	angličtina
Zdroj:	Journal of tropical pediatrics [J Trop Pediatr] 2024 Feb 07; Vol. 70 (2).
DOI:	10.1093/tropej/fmae002
Abstrakt:	Objectives: To conduct a systematic review and meta-analysis of evidence from randomized controlled trials (RCTs) comparing a short course of antibiotics (2-4 days), to a standard course (5-7 days), for the treatment of culture-negative neonatal sepsis. Methods: Relevant databases were searched for RCTs comparing short- vs. standard-course of antibiotics for culture-negative sepsis. The primary outcomes were mortality and treatment failure, defined as the reappearance of clinical signs suggestive of sepsis within 7 days of stoppage of antibiotics. Secondary outcomes included neurological impairment, duration of hospital stay, need for oxygen, respiratory support and double-volume exchange transfusion (DVET). Results: Seven RCTs were included in the review with 729 neonates >30 weeks gestational age at birth. No mortality occurred in either of the groups (2 studies; 276 neonates). Treatment failure rates were similar in the short- and standard-course antibiotic groups [7 studies; 729 neonates; risk ratio (RR) = 1.01; 95% confidence interval (CI), 0.55 to 1.86; very low certainty]. The short course of antibiotics resulted in a shorter hospital stay [3 studies; 293 neonates; mean difference (MD), -2.46 days; 95% CI, -3.16 to -1.75]. There was no difference in the need for oxygen supplementation (2 studies; 258 neonates; RR, 1.40; 95% CI, 0.40 to 4.91), any respiratory support (2 studies; 258 neonates; RR, 1.04; 95% CI, 0.92 to 1.17) or DVET (2 studies; 258 neonates; RR, 1.29; 95% CI, 0.56 to 2.95). Conclusion: Very-low certainty evidence suggests that a short antibiotic course, compared to a standard course, does not affect treatment failure rates in culture-negative neonatal sepsis. There is a need for well-designed RCTs powered enough to assess critical outcomes such as mortality and neurological sequelae to generate stronger evidence and inform guidelines. Prospero Registration Number: CRD42023437199. (© The Author(s) [2024]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu