A new Oxford University research to find out the most effective antibiotics to use in Low- and Middle- Income Countries (LMICs) for neonatal sepsis has revealed that prescribing alternative antibiotics for septic neonates could drastically decrease new-born mortality.
The research, published today in ‘The Lancet Infectious Diseases’, found out that infants with neonatal sepsis who take the recommended combination of ampicillin and gentamicin had a survival rate of 75% over 60 days. Conversely, those prescribed with ceftazidime and amikacin combination had a survival rate of over 90% over the same time.
Previous research found that globally an estimated 214,000 neonatal sepsis deaths are attributable to resistant pathogens each year, so changing the recommendations to ceftazidime and amikacin could drastically reduce this number.
Funded by the Bill and Melinda Gates Foundation, the researchers collected data from Nigeria, Pakistan, Bangladesh, Rwanda, South Africa, Ethiopia, and India and studied over 36,000 infants in these (LMICs) across Africa and South Asia.
Data was procured by Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS), a project run by Professor Tim Walsh, which collected data across seven countries between April 2015 and March 2018. Prof. Walsh joined the University of Oxford in 2021 to help established the Ineos Oxford Institute of Antimicrobial Research.
Lead author 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.”
The World Health Organisation recommends the use of ampicillin and gentamicin for the empirical treatment of neonatal sepsis. Whilst these may be effective in Higher Income Countries (HICs), the researchers indicate there has long been speculation that they were less effective in LMICs due to different levels of antibiotic resistance and variation in common pathogens.
The researchers discovered that some sites are already using different antibiotics to those endorsed by the WHO, due to high resistance against these antibiotics.
These findings will lead to additional follow-up studies; not least, intervention studies related to treatment and ensure that sepsis is treated with appropriate antibiotics and Infection Prevention and Control practices.
The study also investigated the frequency of resistance to various antibiotics, which shows how frequently resistance may arise in susceptible bacteria against different antibiotics.
Whilst varied antibiotics have been suggested for neonatal sepsis, this is the first study that has incorporated frequency of resistance data, allowing insight into how quickly a certain antibiotic could become redundant following extensive use, if selected as an alternative, allowing for more accurate recommendations on which antibiotics to be used. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract.
By Jamila Akweley Okertchiri