***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ( See the Editorial Commentary by Jehan and Qazi on pages 190–1 . ) Background . Integrated Management of Childhood Illness recommends that young infants with isolated fast breathing be referred to a hospital for antibiotic treatment , which is often impractical in re source -limited setting s. Additionally , antibiotics may be unnecessary for physiologic tachypnea in otherwise well newborns . We tested the hypothesis that ambulatory treatment with oral amoxicillin for 7 days was equivalent ( similarity margin of 3 % ) to placebo in young infants with isolated fast breathing in primary care setting s where hospital referral is often unfeasible . Methods . This r and omized equivalence trial was conducted in 4 primary health centers of Karachi , Pakistan . Infants presenting with isolated fast breathing and oxygen saturation ≥90 % were r and omly assigned to receive either oral amoxicillin or placebo twice daily for 7 days . Enrolled infants were followed on days 1–8 , 11 , and 14 . The primary outcome was treatment failure by day 8 , analyzed per protocol . The trial was stopped by the data safety monitoring board due to higher treatment failure rate and the occurrence of 2 deaths in the placebo arm in an interim analysis . Results . Four hundred twenty-three infants fulfilled per protocol criteria in the amoxicillin arm and 426 in the placebo arm . Twelve infants ( 2.8 % ) had treatment failure in the amoxicillin arm and 25 ( 5.9 % ) in the placebo arm ( risk difference , 3.1 ; P value .04 ) . Two infants in the placebo arm died , whereas no deaths occurred in the amoxicillin arm . Other adverse outcomes , as well as the proportions of relapse , were evenly distributed across both study arms . Conclusions . This trial failed to show equivalence of placebo to amoxicillin in the management of isolated fast breathing without hypoxemia or other clinical signs of illness in term young infants . Clinical Trials Registration . NCT01533818 Summary Background Parenteral antibiotic therapy for young infants ( aged 0–59 days ) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality . Outpatient treatment could save lives in such setting s. We aim ed to assess the equivalence of two simplified antibiotic regimens , comprising fewer injections and oral rather than parenteral administration , compared with a reference treatment for young infants with clinical severe infection . Methods We undertook the Simplified Antibiotic Therapy Trial ( SATT ) , a three-arm , r and omised , open-label , equivalence trial in five communities in Karachi , Pakistan . We enrolled young infants ( aged 0–59 days ) who either presented at a primary health-care clinic or were identified by a community health worker with signs of clinical severe infection . We included infants who were not critically ill and whose family refused admission . We r and omly assigned infants to either intramuscular procaine benzylpenicillin and gentamicin once a day for 7 days ( reference ) ; oral amoxicillin twice daily and intramuscular gentamicin once a day for 7 days ; or intramuscular procaine benzylpenicillin and gentamicin once a day for 2 days followed by oral amoxicillin twice daily for 5 days . The primary outcome was treatment failure within 7 days of enrolment and the primary analysis was per protocol . We judged experimental treatments as efficacious as the reference if the upper bound of the 95 % CI for the difference in treatment failure was less than 5·0 . This trial is registered at Clinical Trials.gov , number NCT01027429 . Findings Between Jan 1 , 2010 , and Dec 26 , 2013 , 2780 infants were deemed eligible for the trial , of whom 2453 ( 88 % ) were enrolled . Because of inadequate clinical follow-up or treatment adherence , 2251 infants were included in the per- protocol analysis . 820 infants ( 747 per protocol ) were assigned the reference treatment of procaine benzylpenicillin and gentamicin , 816 ( 751 per protocol ) were allocated amoxicillin and gentamicin , and 817 ( 753 per protocol ) were assigned procaine benzylpenicillin , gentamicin , and amoxicillin . Treatment failure within 7 days of enrolment was reported in 90 ( 12 % ) infants who received procaine benzylpenicillin and gentamicin ( reference ) , 76 ( 10 % ) of those given amoxicillin and gentamicin ( risk difference with reference −1·9 , 95 % CI −5·1 to 1·3 ) , and 99 ( 13 % ) of those treated with procaine benzylpenicillin , gentamicin , and amoxicillin ( risk difference with reference 1·1 , −2·3 to 4·5 ) . Interpretation Two simplified antibiotic regimens requiring fewer injections are equivalent to a reference treatment for young infants with signs of clinical severe infection but without signs of critical illness . The use of these simplified regimens has the potential to increase access to treatment for sick young infants who can not be referred to hospital . Funding The Saving Newborn Lives initiative of Save the Children , through support from the Bill & Melinda Gates , and by WHO and USAID Aims The st and ard treatment of neonatal group B Streptococcus infection is intravenous amoxicillin for 10 days . We investigated whether effective serum amoxicillin concentrations could be reached by switching to oral amoxicillin after 48 h of intravenous administration in full-term neonates with group B Streptococcus infection . Methods Over 2 years , we included 222 full-term neonates who had early onset group B streptococcal disease responsive to 48 h of intravenous amoxicillin , at which point they were asymptomatic and fed orally . They were switched to oral amoxicillin ( 300 or 200 mg/kg per day in four divided doses ) . Steady-state serum amoxicillin concentrations were determined 48 h later by high-performance liquid chromatography ; values ≥5 mg/l were considered effective . Results Mean gestational age was 39.32 ± 1.5 weeks , and mean birth weight was 3,422 ± 533 g ; 29 newborns were bacteremic . Median serum amoxicillin concentration on oral therapy was 31,.15 ( range 11–118 ) and 25.80 ( range 5–84.8 ) with 300 and 200 mg/kg per day , respectively . None of the infants had a concentration < 5 mg/l ( p < 0.001 ) . Gastrointestinal tolerance was satisfactory ; 216 patients were discharged at 5 days of age , and none was readmitted within the 3-month follow-up . Conclusion Early switching to the oral route in asymptomatic full-term newborns with early onset group B streptococcal disease  maintained serum amoxicillin concentrations within our predefined therapeutic range ( error risk<0.001 ) . This strategy may hold potential for reducing treatment invasiveness and shortening hospital length of stay Background The acquisition and development of infant gut microbiota can be influenced by numerous factors , of which early antibiotic treatment is an important one . However , studies on the effects of antibiotic treatment in early life on clinical outcomes and establishment and development of the gut microbiota of term infants are limited . Disturbed microbiota composition is hypothesized to be an underlying mechanism of an aberrant development of the immune system . This study aims to investigate the potential clinical and microbial consequences of empiric antibiotic use in early life . Methods / Design 450 term born infants , of whom 150 are exposed to antibiotic treatment in early life and 300 are not ( control group ) , are included in this observational cohort study with a one-year follow-up . Clinical outcomes , including coughing , wheezing , fever > 38 ° C , runny nose , glue ear , rash , diarrhea and > 3 crying hours a day , are recorded daily by parents and examined by previously defined doctor ’s diagnosis . A blood sample is taken at closure to investigate the infant ’s vaccination response and sensitization for food and inhalant allergens . Fecal sample s are obtained at eight time points during the first year of life . Potential differences in microbial profiles of infants treated with antibiotics versus healthy controls will be determined by use of 16S-23S  rRNA gene analysis ( IS-pro ) . Microbiota composition will be described by means of abundance , diversity and (dis)similarity . Diversity is calculated using the Shannon index . Dissimilarities between sample s are calculated as the cosine distance between each pair of sample s and analyzed with principal coordinate analysis . Clinical variables and possible associations are assessed by appropriate statistics . Discussion Both clinical quantitative and qualitative microbial effects of antibiotic treatment in early life may be demonstrated . These findings can be important , since there is evidence that manipulation of the infant microbiota by using pre- or probiotics can restore the ecological balance of the microbiota and may mitigate potential negative effects on the developing immune system , when use of antibiotics can not be avoided . Trial registration Clinical Trials.gov NCT02536560 . Registered 28 August 2015 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The amoxicillin is a drug that for the incomplete capacity of intestinal absorption in newborn is give for intravenous way . The use of this way and the duration of treatment impose the separation of the newborn from mother and a proportionate preparation of the nurses for the execution of this therapy . We have compared , in newborn infants , with clinical and laboratory diagnosis of neonatal infection , the amoxicillin 's plasmatic concentration after intravenous giving and oral giving , in relation to minimum inhibiting concentration the bacteria cause of neonatal infections . In our study ( duration 10 months ) the newborn infants were perfectly comparable for gestational age , Apgar 's score , birthweight , breastfeeding . The newborn infants , at r and om , were divided in two groups ; the first group ( 18 newborns ) received drug for oral way , the second group ( 14 newborns )  for intravenous way . The dosage was 40 mg/Kg/dose of amoxicillin . The duration of treatment was 4 days . Remarkable was the great individual variability of plasmatic concentration of amoxicillin independently from way of giving . The plasmatic concentrations were nearly similar except for the first half hour ( plasmatic concentrations after oral giving was lower ) . The use of oral way is , therefore , favourable for the facility of giving and effective as the intravenous way in the control of neonatal infections BACKGROUND WHO recommends hospital-based treatment for young infants aged 0 - 59 days with clinical signs of possible serious bacterial infection , but most families in re source -poor setting s can not accept referral . We aim ed to assess whether use of simplified antibiotic regimens to treat young infants with clinical signs of severe infection was as efficacious as an injectable procaine benzylpenicillin-gentamicin combination for 7 days for situations in which hospital referral was not possible . METHODS In a multisite open-label equivalence trial in DR Congo , Kenya , and Nigeria , community health workers visited all newborn babies at home , identifying and referring unwell young infants to a study nurse . We stratified young infants with clinical signs of severe infection whose parents did not accept referral to hospital by age ( 0 - 6 days and 7 - 59 days ) , and r and omly assigned each individual within these strata to receive one of the four treatment regimens . R and omisation was stratified by age group of infants . An age-stratified r and omisation scheme with block size of eight was computer-generated off-site at WHO . The outcome assessor was masked . We r and omly allocated infants to receive injectable procaine benzylpenicillin-gentamicin for 7 days ( group A , reference group ) ; injectable gentamicin and oral amoxicillin for 7 days ( group B ) ; injectable procaine benzylpenicillin-gentamicin for 2 days , then oral amoxicillin for 5 days ( group C ) ; or injectable gentamicin for 2 days and oral amoxicillin for 7 days ( group D ) . Trained health professionals gave daily injections and the first dose of oral amoxicillin . Our primary outcome was treatment failure by day 8 after enrolment , defined as clinical deterioration , development of a serious adverse event ( including death ) , no improvement by day 4 , or not cured by day 8 . Independent outcome assessors , who did not know the infant 's treatment regimen , assessed study outcomes on days 4 , 8 , 11 , and 15 . Primary analysis was per protocol . We used a prespecified similarity margin of 5 % to assess equivalence between regimens . This study is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12610000286044 . FINDINGS In Kenya and Nigeria , we started enrolment on April 4 , 2011 , and we enrolled the necessary number of young infants aged 7 days or older from Oct 17 , 2011 , to April 30 , 2012 . At these sites , we continued to enrol 
    Output:
    
Compared with parenteral administration , oral antibiotics generally reach their maximum concentration later and have a lower bioavailability , but in the majority of cases adequate serum levels for bacterial killing are reached .
Oral antibiotics administered to neonates are absorbed and result in adequate serum levels , judged by MICs of relevant pathogens , over time .
Early oral antibiotic switch therapy in neonates could be beneficial for both families and healthcare systems .