A randomized, controlled trial of parenteral clindamycin in neonatal necrotizing enterocolitis.
For an assessment of the efficacy of clindamycin in preventing bowel necrosis (intestinal gangrene or perforation), 42 premature infants with radiographically confirmed necrotizing enterocolitis (NEC) (pneumatosis, intraportal gas, or both) were randomly assigned to receive parenterally either ampicillin and gentamicin (control group, n = 22) or ampicillin, gentamicin, and clindamycin (n = 20), 20 mg/kg/d at 8-hour intervals for 10 to 14 days. Infants who had received antibiotics for greater than 24 hours before randomization and those developing intestinal gangrene or perforation less than 12 hours after randomization were excluded. Intestinal gangrene or perforation developed in four infants in the control group and six in the clindamycin group. Four in each group died of NEC. In the control group, one of 18 survivors developed a late stricture requiring surgical resection, whereas six of 15 survivors in the clindamycin group developed such strictures (P = 0.022). Routine inclusion of clindamycin in medical treatment of NEC does not reduce the frequency of intestinal gangrene or perforation and may be associated with an increase in late stricture formation.
Faix
R G
RG
Department of Pediatrics and Communicable Diseases, College of Pharmacy, University of Michigan Medical Center, Ann Arbor 48109-0254.
Polley
T Z
TZ
Grasela
T H
TH
D001826:Body Fluids / Q000382:microbiology; D002981:Clindamycin / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003251:Constriction, Pathologic / Q000601:surgery; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005734:Gangrene; D006801:Humans; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D007416:Intestinal Perforation / Q000209:etiology / Q000517:prevention & control; D007422:Intestines / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D010537:Peritoneum / Q000378:metabolism; D011446:Prospective Studies; D011897:Random Allocation
D002981:Clindamycin