In last three decades, our understanding about pathophysiology of Necrotizing enterocolitis (NEC) has improved. There is a high degree of variability in the antibiotic regimen for the treatment of NEC, even within a single treating unit, with no regimen appearing superior over another. A recent study by Blackwood, et al. [1] documented that 22 different pre-operative antibiotic regimens were used with average duration of 10.6 d (mode 14 d). The 15 different post-operative antibiotic regimens had an average duration of 6.6 d (mode 2 d) [1].

An international survey done by Zani, et al. [2] on the management of NEC documented that most (67%) surgeons use a combination of two (51%) or three (48%) antibiotics for more than 7 days, and keep patients nil-by-mouth for 7 (41%) or 10 (49%) days. Currently, there is no consensus in the literature about the antibiotic regimen for neonates with NEC [2].

The Cochrane review by Shah, et al. [3] concluded that there is insufficient evidence to recommend a particular antibiotic regimen for NEC. There has been no randomized trial in this area since late 1980s. As prolonged antibiotics usage is associated with dysbiosis and affects neonatal outcomes, there is urgent need to optimize antibiotic therapy.

1. Blackwood BP, Hunter CJ, Grabowski J. Variability in antibiotic regimens for surgical necrotizing enterocolitis highlights the need for new guidelines. Surg Infect. 2017;18:215-20.

2. Zani A, Eaton S, Puri P, Rintala R, Lukac M, Bagolan P, et al. International survey on the management of necrotizing enterocolitis. Eur J Pediatr Surg. 2015;25:27-33.

3. Shah D, Sinn JK. Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis. Cochrane Database Syst Rev. 2012:CD007448.