NumberResearch recommendations
Duration of antibiotic treatment
RR 12What is the clinical and cost effectiveness of laboratory investigations used individually or in combination to exclude early-onset neonatal infection in babies receiving antibiotics for suspected infection?
Why this is important
The systematic reviews conducted for the guideline identified limited evidence relating to investigations used to guide the decision to stop antibiotic treatment in babies receiving antibiotics for suspected early-onset neonatal infection. One study evaluated procalcitonin-guided decision making for identifying babies in whom antibiotic treatment could safely be stopped, but the approach used was at an early stage of development and had not been evaluated fully.
The guideline recommendations reflected uncertainty about the diagnostic test accuracy of laboratory investigations used individually or in combination, and further research involving sufficiently powered studies is needed to evaluate this. The ideal study design would be a randomised controlled trial that compares clinical outcomes associated with particular investigation and treatment termination strategies. The next best design would be a prospective cohort study to determine the diagnostic test accuracy of an investigation strategy evaluated in a clinically relevant group of babies. The research should examine clinical effectiveness or diagnostic test accuracy in preterm and term babies separately.
RR 13What is the optimal duration of treatment (course length) in babies who receive antibiotics for confirmed early-onset neonatal infection?
Why this is important
The Guideline Development Group identified no evidence to inform the choice of duration of antibiotic treatment (course length) for confirmed early-onset neonatal infection. In the absence of evidence, the Guideline Development Group based its recommendations on its knowledge of current clinical practice. Further research is needed to evaluate different course lengths in the following clinical circumstances: The research should ideally take the form of multinational randomised controlled trials. The primary outcome should be relapse within 10 days of stopping treatment. Secondary outcomes should include long-term neurodevelopment.

From: 10, Duration of antibiotic treatment

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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