Oral antibiotics in the management of serious neonatal bacterial infections in developing country communities

Background: Parenteral antibiotic therapy is the standard of care for treatment of serious neonatal infections. This may not be possible, however, in some developing country settings with limited health systems capacity. Methods: We reviewed the evidence for treatment of neonatal infections in developing countries with oral antibiotics, evaluated properties of oral agents that could be considered, and identified priority research questions. Results: Case management of pneumonia in developing country community settings suggests that this strategy has resulted in substantial reductions in neonatal mortality. However, limited available data indicate that injectable antibiotic therapy is superior to oral regimens. Conclusions: Parenteral therapy should be used for treatment of serious neonatal infections whenever possible. In settings in which this is not possible, however, oral antibiotic therapy is superior to no antibiotic therapy. Further research is needed to define subgroups of patients and settings in which therapy with oral agents is ethical and effective.