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. 1998 Sep;79(2):F105–F109. doi: 10.1136/fn.79.2.f105

Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants

Y Siu, P Ng, S Fung, C Lee, M Wong, T Fok, K So, K Cheung, W Wong, A Cheng
PMCID: PMC1720837  PMID: 9828735

Abstract

AIMS—To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis in preterm, very low birthweight infants.
METHODS—A prospective, double blind, randomised, 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 randomly 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.



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Selected References

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  1. Albanese C. T., Rowe M. I. Necrotizing enterocolitis. Semin Pediatr Surg. 1995 Nov;4(4):200–206. [PubMed] [Google Scholar]
  2. Beck-Sague C. M., Azimi P., Fonseca S. N., Baltimore R. S., Powell D. A., Bland L. A., Arduino M. J., McAllister S. K., Huberman R. S., Sinkowitz R. L. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J. 1994 Dec;13(12):1110–1116. [PubMed] [Google Scholar]
  3. Deitch E. A. Role of bacterial translocation in necrotizing enterocolitis. Acta Paediatr Suppl. 1994;396:33–36. doi: 10.1111/j.1651-2227.1994.tb13239.x. [DOI] [PubMed] [Google Scholar]
  4. Dever L. L., Smith S. M., Handwerger S., Eng R. H. Vancomycin-dependent Enterococcus faecium isolated from stool following oral vancomycin therapy. J Clin Microbiol. 1995 Oct;33(10):2770–2773. doi: 10.1128/jcm.33.10.2770-2773.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Egan E. A., Mantilla G., Nelson R. M., Eitzman D. V. A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis. J Pediatr. 1976 Sep;89(3):467–470. doi: 10.1016/s0022-3476(76)80553-7. [DOI] [PubMed] [Google Scholar]
  6. Farrag N., Eltringham I., Liddy H. Vancomycin-dependent Enterococcus faecalis. Lancet. 1996 Dec 7;348(9041):1581–1582. doi: 10.1016/S0140-6736(96)24049-8. [DOI] [PubMed] [Google Scholar]
  7. Grylack L. J., Scanlon J. W. Oral gentamicin therapy in the prevention of neonatal necrotizing enterocolitis. A controlled double-blind trial. Am J Dis Child. 1978 Dec;132(12):1192–1194. doi: 10.1001/archpedi.1978.02120370040010. [DOI] [PubMed] [Google Scholar]
  8. Han V. K., Sayed H., Chance G. W., Brabyn D. G., Shaheed W. A. An outbreak of Clostridium difficile necrotizing enterocolitis: a case for oral vancomycin therapy? Pediatrics. 1983 Jun;71(6):935–941. [PubMed] [Google Scholar]
  9. Kaplan A. H., Gilligan P. H., Facklam R. R. Recovery of resistant enterococci during vancomycin prophylaxis. J Clin Microbiol. 1988 Jun;26(6):1216–1218. doi: 10.1128/jcm.26.6.1216-1218.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Khadilkar V., Tudehope D., Fraser S. A prospective study of nosocomial infection in a neonatal intensive care unit. J Paediatr Child Health. 1995 Oct;31(5):387–391. doi: 10.1111/j.1440-1754.1995.tb00843.x. [DOI] [PubMed] [Google Scholar]
  11. Kliegman R. M., Fanaroff A. A. Necrotizing enterocolitis. N Engl J Med. 1984 Apr 26;310(17):1093–1103. doi: 10.1056/NEJM198404263101707. [DOI] [PubMed] [Google Scholar]
  12. Kosloske A. M. Epidemiology of necrotizing enterocolitis. Acta Paediatr Suppl. 1994;396:2–7. doi: 10.1111/j.1651-2227.1994.tb13232.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. MacKendrick W., Caplan M. Necrotizing enterocolitis. New thoughts about pathogenesis and potential treatments. Pediatr Clin North Am. 1993 Oct;40(5):1047–1059. doi: 10.1016/s0031-3955(16)38622-9. [DOI] [PubMed] [Google Scholar]
  14. Mollitt D. L., Tepas J. J., 3rd, Talbert J. L. The microbiology of neonatal peritonitis. Arch Surg. 1988 Feb;123(2):176–179. doi: 10.1001/archsurg.1988.01400260056006. [DOI] [PubMed] [Google Scholar]
  15. Mollitt D. L., Tepas J. J., Talbert J. L. The role of coagulase-negative Staphylococcus in neonatal necrotizing enterocolitis. J Pediatr Surg. 1988 Jan;23(1 Pt 2):60–63. doi: 10.1016/s0022-3468(88)80542-6. [DOI] [PubMed] [Google Scholar]
  16. Ng P. C., Dear P. R., Thomas D. F. Oral vancomycin in prevention of necrotising enterocolitis. Arch Dis Child. 1988 Nov;63(11):1390–1393. doi: 10.1136/adc.63.11.1390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ng P. C., Fok T. F., Lee C. H., Wong W., Cheung K. L. Erythromycin treatment for gastrointestinal dysmotility in preterm infants. J Paediatr Child Health. 1997 Apr;33(2):148–150. doi: 10.1111/j.1440-1754.1997.tb01018.x. [DOI] [PubMed] [Google Scholar]
  18. Ng P. C., Thomson M. A., Dear P. R. Dexamethasone and infection in preterm babies: a controlled study. Arch Dis Child. 1990 Jan;65(1 Spec No):54–56. doi: 10.1136/adc.65.1_spec_no.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Philip A. G. The changing face of neonatal infection: experience at a regional medical center. Pediatr Infect Dis J. 1994 Dec;13(12):1098–1102. doi: 10.1097/00006454-199412000-00005. [DOI] [PubMed] [Google Scholar]
  20. Schwalbe R. S., Stapleton J. T., Gilligan P. H. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med. 1987 Apr 9;316(15):927–931. doi: 10.1056/NEJM198704093161507. [DOI] [PubMed] [Google Scholar]
  21. Walsh M. C., Kliegman R. M. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986 Feb;33(1):179–201. doi: 10.1016/S0031-3955(16)34975-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Willoughby R. E., Jr, Pickering L. K. Necrotizing enterocolitis and infection. Clin Perinatol. 1994 Jun;21(2):307–315. doi: 10.1016/S0095-5108(18)30347-6. [DOI] [PMC free article] [PubMed] [Google Scholar]

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