title: Feasibility and efficacy of gentamicin for treating neonatal sepsis in community-based settings: a systematic review.
abstract: BACKGROUND
  Neonatal sepsis is a leading cause of neonatal deaths in developing countries. The current recommended in-hospital treatment is parenteral ampicillin (or penicillin) and gentamicin in young infants for 10- 14 days; however, very few could access and afford. The current review is to evaluate the feasibility of gentamicin in community based settings.
  
  
  METHODS
  Both observational and randomized controlled trials were included. Medline, Embase, Cochrane Central Register of Controlled Trials and Central Trial Register of India were searched until September 2013. We assessed the risk of bias by Cochrane Collaboration's "risk of bias" tool.
  
  
  RESULTS
  Two observational studies indicated feasibility ensuring coverage of population, decrease in case fatality rate in the group treated by community health workers. In an RCT, no significant difference was observed in the treatment failure rates [odds ratio (OR)=0.88], and the mortality in the first and second week (OR=1.53; OR=2.24) between gentamicin and ceftriaxone groups. Within the gentamicin group, the combination of penicillin and gentamicin showed a lower rate of treatment failure (OR=0.44) and mortality at second week of life (OR=0.17) as compared to the combination of gentamicin and oral cotrimoxazole.
  
  
  CONCLUSIONS
  Gentamicin for the treatment of neonatal sepsis is both feasible and effective in community-based settings and can be used as an alternative to the hospitalbased care in resource compromised settings. But there was less evidence in the management of neonatal sepsis in hospitals as was seen in this review in which we included only one RCT and three observational studies.
authors.affiliation: ICMR Advanced Centre for Evidence Based Child Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Nishant
authors.initials: N
authors.lastname: Jaiswal
authors.affiliation: ICMR Advanced Centre for Evidence Based Child Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.|Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Meenu
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors.forename: Ritika
authors.initials: R
authors.lastname: Kondel
authors.affiliation: Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors.forename: Navjot
authors.initials: N
authors.lastname: Kaur
authors.affiliation: ICMR Advanced Centre for Evidence Based Child Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Thumburu
authors.affiliation: ICMR Advanced Centre for Evidence Based Child Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Library, University Business School, Punjab University, Chandigarh, India.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Kaur
authors.affiliation: Dr. Tulsi Das Library, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Neelima
authors.initials: N
authors.lastname: Chadha
authors.affiliation: Department of Pediatrics, AIIMS, Jodhpur, Rajasthan, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Gupta
authors.affiliation: ICMR Advanced Centre for Evidence Based Child Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Malhotra
authors.affiliation: Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. nusrat_shafiq@hotmail.com.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Shafiq
mesh_terms: D002423:Cause of Death; D003153:Community Health Services; D003906:Developing Countries; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008297:Male; D000071074:Neonatal Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005839:Gentamicins
keywords: gentamicin; neonatal sepsis; neonates
references.citation: J Perinatol. 2005 Mar;25 Suppl 1:S62-71
references.pmid: 15791280
references.citation: Semin Perinatol. 2010 Dec;34(6):416-25
references.pmid: 21094416
references.citation: J Pediatr. 1997 Jul;131(1 Pt 1):76-80
references.pmid: 9255195
references.citation: Pediatr Infect Dis J. 2013 Sep;32 Suppl 1:S19-25
references.pmid: 23945571
references.citation: PLoS Med. 2011 Aug;8(8):e1001080
references.pmid: 21918640
references.citation: Lancet. 1999 Dec 4;354(9194):1955-61
references.pmid: 10622298
references.citation: Bull World Health Organ. 2006 Sep;84(9):706-13
references.pmid: 17128340
references.citation: Arch Dis Child. 2013 Feb;98(2):146-54
references.pmid: 23142784
references.citation: Indian Pediatr. 1997 Dec;34(12):1075-80
references.pmid: 9715552
references.citation: Pediatr Infect Dis J. 2012 Jul;31(7):667-72
references.pmid: 22481421
references.citation: PLoS Med. 2010 Mar 09;7(3):e1000213
references.pmid: 20231868
references.citation: Pediatrics. 2006 Jan;117(1):67-74
references.pmid: 16396862
references.citation: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004495
references.pmid: 15495114
references.citation: Lancet. 2005 Mar 5-11;365(9462):891-900
references.pmid: 15752534
references.citation: Lancet. 2004 Jul 31-Aug 6;364(9432):399-401
references.pmid: 15288723
references.citation: Pediatr Clin North Am. 2013 Apr;60(2):367-89
references.pmid: 23481106
references.citation: Pediatr Infect Dis J. 2013 Sep;32 Suppl 1:S12-8
references.pmid: 23945570