Cochrane · systematic review · CD007646
Community‐based antibiotic delivery for possible serious bacterial infections in neonates in low‐ and middle‐income countries
Duby, J, Lassi, ZS, Bhutta, ZA · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
NeonatalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
38
current version
GRADE rated
26
No studies
12
Included studies
NR
No studies 12 · 31.6%Ungraded 0 · 0%Very low 1 · 2.6%Low 7 · 18.4%Moderate 17 · 44.7%High 1 · 2.6%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Comparison 1: community‐based antibiotic delivery compared to standard care for the management of neonatal possible serious bacterial infection
Population: neonates with sepsis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality Comparison 1: community‐based antibiotic delivery vs standard care | RR 0.82 [0.68, 0.99] | 5 studies · 125134 participants | Low |
Early neonatal mortality Comparison 1: community‐based antibiotic delivery vs standard care | RR 0.74 [0.65, 0.85] | 2 studies · 40299 participants | Moderate |
Late neonatal mortality Comparison 1: community‐based antibiotic delivery vs standard care | RR 0.73 [0.55, 0.96] | 2 studies · 40142 participants | Moderate |
Sepsis‐specific mortality Comparison 1: community‐based antibiotic delivery vs standard care | RR 0.78 [0.6, 1] | 2 studies · 40233 participants | Low |
Comparison 1: referral or full course of antibiotics compared to standard care for health problem or population
Population: neonates with sepsis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality ‐ first dose and referral Comparison 1: referral or full course of antibiotics vs standard care | RR 0.57 [0.38, 0.83] | 1 study · 3355 participants | Low |
Neonatal mortality ‐ full course Comparison 1: referral or full course of antibiotics vs standard care | RR 0.87 [0.72, 1.04] | 4 studies · 121779 participants | Very low |
Comparison 1: route of antibiotic compared to standard care for the management of neonatal sepsis
Population: neonates with sepsis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality ‐ oral antibiotic Comparison 1: route of antibiotic vs standard care | RR 0.7 [0.54, 0.9] | 2 studies · 40223 participants | Low |
Neonatal mortality ‐ injectable antibiotic Comparison 1: route of antibiotic vs standard care | RR 0.67 [0.51, 0.88] | 1 study · 5684 participants | Moderate |
Neonatal mortality ‐ oral + injectable antibiotics Comparison 1: route of antibiotic vs standard care | RR 0.99 [0.92, 1.06] | 2 studies · 79227 participants | Moderate |
Comparison 1: antibiotic alone or antibiotic with other newborn care interventions compared to standard care for the management of neonatal sepsis
Population: neonates with sepsis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality ‐ antibiotics alone Comparison 1: antibiotic alone or antibiotic with other newborn care interventions vs standard care | RR 1.07 [0.89, 1.29] | 1 study · 18747 participants | Moderate |
Neonatal mortality ‐ antibiotics with other newborn care interventions Comparison 1: antibiotic alone or antibiotic with other newborn care interventions vs standard care | RR 0.76 [0.62, 0.94] | 4 studies · 106387 participants | Moderate |
Comparison 2: any simplified antibiotic regimen compared to the standard antibiotic regimen (7 days injectable benzylpenicillin + injectable gentamicin)
Population: neonates with possible serious bacterial infection
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality Comparison 2: any simplified antibiotic regimen vs the standard antibiotic regimen (7 days injectable benzylpenicillin + injectable gentamicin) | RR 0.81 [0.44, 1.5] | 3 studies · 3476 participants | Moderate |
Treatment failure Comparison 2: any simplified antibiotic regimen vs the standard antibiotic regimen (7 days injectable benzylpenicillin + injectable gentamicin) | RR 0.86 [0.67, 1.1] | 3 studies · 3476 participants | Moderate |
Adverse events Comparison 2: any simplified antibiotic regimen vs the standard antibiotic regimen (7 days injectable benzylpenicillin + injectable gentamicin) | RR 1.38 [0.79, 2.41] | 3 studies · 3476 participants | Moderate |
Comparison 2: 7 days oral amoxicillin + injectable gentamicin compared to 7 days injectable benzylpenicillin + injectable gentamicin
Population: possible serious bacterial infections in neonates
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality Comparison 2: 7 days oral amoxicillin + injectable gentamicin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.84 [0.47, 1.51] | 3 studies · 2001 participants | Moderate |
Early neonatal mortality Comparison 2: 7 days oral amoxicillin + injectable gentamicin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Late neonatal mortality Comparison 2: 7 days oral amoxicillin + injectable gentamicin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Sepsis‐specific neonatal mortality Comparison 2: 7 days oral amoxicillin + injectable gentamicin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Treatment failure Comparison 2: 7 days oral amoxicillin + injectable gentamicin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.82 [0.6, 1.11] | 3 studies · 2001 participants | Moderate |
Adverse events Comparison 2: 7 days oral amoxicillin + injectable gentamicin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 1.35 [0.72, 2.53] | 3 studies · 2001 participants | Moderate |
Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin compared to 7 days injectable benzylpenicillin + injectable gentamicin
Population: neonates with possible serious bacterial infections
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.88 [0.29, 2.65] | 3 studies · 2036 participants | Low |
Early neonatal mortality Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Late neonatal mortality Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Sepsis‐specific neonatal mortality Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Treatment failure Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.93 [0.7, 1.25] | 3 studies · 2036 participants | Moderate |
Adverse events Comparison 2: 2 days injectable benzylpenicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 1.39 [0.67, 2.87] | 3 studies · 2036 participants | Moderate |
Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin compared to 7 days injectable benzylpenicillin + injectable gentamicin
Population: neonates with possible serious bacterial infection
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.67 [0.24, 1.85] | 1 study · 893 participants | Moderate |
Early neonatal mortality Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Late neonatal mortality Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Sepsis‐specific neonatal mortality Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Treatment failure Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.67 [0.24, 1.85] | 1 study · 893 participants | Moderate |
Adverse events Comparison 2: 2 days oral amoxicillin + injectable gentamicin followed by 5 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | 1 study · 893 participants | High |
Comparison 2: 7 days oral amoxicillin compared to 7 days injectable benzylpenicillin + injectable gentamicin for fast breathing alone
Population: neonates with fast breathing alone
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neonatal mortality Comparison 2: 7 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.99 [0.2, 4.91] | 1 study · 1406 participants | Low |
Early neonatal mortality Comparison 2: 7 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Late neonatal mortality Comparison 2: 7 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Sepsis‐specific neonatal mortality Comparison 2: 7 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | NR | No studies |
Treatment failure Comparison 2: 7 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | RR 0.83 [0.68, 1.01] | 1 study · 1406 participants | Low |
Adverse events Comparison 2: 7 days oral amoxicillin vs 7 days injectable benzylpenicillin + injectable gentamicin | no estimate extracted | 1 study · 1406 participants | Moderate |