Which medications in the drug class Antibiotics are used in the treatment of Necrotizing Enterocolitis?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Although no single infectious etiology is known to cause necrotizing enterocolitis (NEC), clinical consensus finds that antibiotic treatment is appropriate. Broad-spectrum parenteral therapy is initiated at the onset of symptoms after obtaining blood, spinal fluid, and urine for culture. Antibiotic coverage for staphylococcus should be considered in NICUs that have a high colonization rate. Antifungal therapy should be considered for premature infants with a history of recent or prolonged antibacterial therapy or for babies who continue to deteriorate clinically or hematologically despite adequate antibacterial coverage.

Various antibiotic regimens can be employed; one frequently used regimen includes ampicillin, aminoglycoside (eg, gentamicin) or third-generation cephalosporin (cefotaxime), and clindamycin or metronidazole. Vancomycin should be included if staphylococcus coverage is deemed appropriate. This combination provides broad gram-positive coverage (including staphylococcal species), excellent gram-negative coverage (with the exception of pseudomonads), and anaerobic coverage.

Doses are adapted from Neofax. [61] Postmenstrual age (PMA) is equivalent to gestational age plus postnatal age. Postnatal age is used as a secondary qualifier to determine dose.

Cefotaxime (Claforan)

Cefotaxime is a broad-spectrum, third-generation cephalosporin with excellent nonpseudomonal, gram-negative coverage at the expense of gram-positive effects. Its safety profile is more favorable than that for aminoglycosides. Cefotaxime penetrates cerebrospinal fluid to treat meningitis.


Ampicillin is a broad-spectrum penicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Ampicillin is an alternative to amoxicillin when medication cannot be taken orally. Previously, the HACEK bacteria were uniformly susceptible to ampicillin. However, beta-lactamase–producing strains of HACEK have been identified.


Gentamicin is an aminoglycoside antibiotic for gram-negative coverage of bacteria, including Pseudomonas species. It is synergistic with beta lactamase against enterococci. Gentamicin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits. Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as the body space into which the agent needs to distribute. Monitor gentamicin by serum levels obtained before the third or fourth dose (0.5 h before dosing); the peak level may be drawn 0.5 hour after a 30-minute infusion.

Vancomycin (Vancocin)

Vancomycin provides excellent gram-positive coverage, including of methicillin-resistant Staphylococcus species and Streptococcus species. The drug blocks bacterial cell wall synthesis. The parenteral formulation is widely bioavailable throughout all body tissues and fluids, including cerebrospinal fluid. Vancomycin is recommended for empiric use in patients with central lines and ventriculoperitoneal (VP) shunts, and for those with probable staphylococcal or streptococcal infection. Enteral administration is used for Clostridium difficile intoxication.

Clindamycin (Cleocin)

Clindamycin inhibits bacterial protein synthesis; it is bacteriostatic or bacteriocidal, depending on the drug concentration and organism. Coverage includes anaerobes commonly found in the intestinal tract and many staphylococcal and streptococcal species.

Metronidazole (Flagyl)

Metronidazole is used to treat susceptible anaerobic bacterial and protozoal intraabdominal, systemic, or central nervous system (CNS) infections.

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