Global guidelines for treatment of neonatal sepsis should be changed to advise different antibiotics in poor countries, according to the findings of a major study published today.
The World Health Organization advises the use of ampicillin and gentamicin – but, according to the UK-based researchers, ceftazidime and amikacin are both more effective and less likely to face antibiotic resistance.
According to the study, the existing treatment gives a survival rate of 75% over 60s in low and middle income countries – while the proposed new treatment gives a 90% survival rate.
The research, in Lancet Infectious Diseases, studied outcomes for more than 36,000 babies in more than seven countries with support from the Bill and Melinda Gates Foundation. The work has been undertaken by microbiologists at the Division of Infection and Immunity, Cardiff, and the University of Oxford.
Neonatal sepsis affects some 2.5 million infants a year, largely in sub-Saharan Africa and Asia.
Researcher Kathryn Thomson said: “Extremely high resistance (>97%) was found against ampicillin in Gram-negative sepsis causing isolates analysed from BARNARDS sites. Furthermore, only 28.5% of Gram-negative isolates were susceptible to at least one of the combined antibiotic therapy of ampicillin and gentamicin.
“While this may be a suitable empirical treatment for neonatal sepsis in high income countries, this data showcases that it is not an effective option for LMICs, who have different common pathogens and vastly increased resistance against these antibiotics.
“Many LMIC sites depend on recommended therapies, due to a lack of microbiology facilities to detect common species or resistance profiles. Therefore, further work is urgently needed to improve the sparsity of data in LMICs regarding prevalence and AMR in neonatal sepsis.”
Lancet Infectious Diseases 10 August 2021
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