| Neonatal septicemia remains one of the major causes of morbidity and mortality during the neonatal period[1,2].Treatment should be initiated without any delay once there is a suspicion of sepsis.Concurrently,the recommended frontline empirical treatment contains penicillin or ampicillin and an aminoglycoside,with a third-generation cephalosporin as an alternative[3-6].We carried out this systematic review to compare effectiveness,estimate adverse effects and bacterial resistance of these antibiotic treatments for suspected neonatal septicemia.Appropriate search strategies were performed and only randomized controlled studies were included.Four studies,in 1728 neonates,were yielded for meta-analysis[7-10].Intrialscomparingthird-generationcephalosporin?TGC?monotherapy versus combination of aminoglycoside?AG?with penicillin or penicillin analogues?PNs?,we observed no difference in mortality prior to discharge from hospital?RR 1.25,95%CI 0.50 to 3.11?,treatment responder?RR 0.98,95%CI 0.87 to 1.09?and complications resulting from sepsis?RR 0.43,95%CI 0.11 to 1.62?.Meta-analysis of these studies revealed a reduction in the rates of treatment failure?RR 2.62,95%CI 1.18to 5.84?.In trials comparing TGC+PNs versus combination of AG+PNs,we observed no difference in mortality prior to discharge from hospital?RR1.00,95%CI 0.20 to 4.91?,treatment responder?RR 1.07,95%CI 0.94 to1.22?and treatment failure?RR 0.43,95%CI 0.10 to 1.82?.No data for subgroup analysis were obtained from the included studies.The empirical use of TGC monotherapies for neonatal septicemia shou ld be discouraged compared to the combination of AG+PNs.Based on the c urrent evidence,the combination of TGC+PNs showed no difference to the combination of AG+PNs in the aspects discussed in our meta-analysis. |
PDF Full Text Request