Changing antibiotics could lower cases of neonatal sepsis
Infant deaths could be prevented following new research into choice of drugs in poor countries
Neonatal sepsis is a blood infection that occurs in infants younger than 90 days old . According to a wide-ranging study of tens of thousands of infants in Africa and South Asia , current methods of antibiotic treatment for the condition differ in different parts of the developing world , resulting in higher death rates in certain countries .
The new research could potentially save countless lives by increasing the effective treatment of a condition that causes an estimated 2.5 million infant deaths annually , particularly in low- and middle-income countries that often have reduced access to resources such as laboratory facilities .
The British study also highlighted how economic issues can affect treatment costs and raise other barriers to dealing with neonatal sepsis .
Researchers from Oxford University and an international network of microbiologists combined microbiological , genomic , epidemiological , pharmacodynamic , and economic data for the first time to study the efficacy of various antibiotic treatments in Nigeria , Pakistan , Bangladesh , Rwanda , South Africa , Ethiopia , and India . They assessed what sepsis-causing pathogens were present in these countries in order to learn more about associated antimicrobial resistance .
“ Usually , the causes of sepsis vary between regions , and there is different susceptibility . For example , the causes of fever in Africa may be quite different from what we see in New Zealand , with different comorbities and population structures ,” Dr Nigel Raymond , chair of the New Zealand Committee of the Australian Society of Infectious Diseases , told Global Health Asia-Pacific . “ That is why different antibiotics are used in different parts of the world .”
The World Health Organization recommends ampicillin and gentamicin for the treatment of neonatal sepsis . While these may be effective in wealthier nations , there has long been speculation that they were less effective in poorer countries 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 . Infants who were prescribed the recommended combination of ampicillin and gentamicin had a survival rate of 75 percent over 60 days . In contrast , infants prescribed ceftazidime and amikacin had a survival rate of over 90 percent over the same period .
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 .
The study also investigated the frequency of resistance to various antibiotics . While a variety of antibiotics has 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 . The results will enable more accurate recommendations to be made on which antibiotics to use .
In terms of the economic impact of antibiotic use , the study examined average earnings versus the costs of certain antibiotics in different countries . It found , for example , that piperacillin-tazobactam costs US $ 2.60 per day in India , which is a massive 76 percent of the average daily wage . By contrast , it costs US $ 20 a day in Nigeria , representing between 219 and 741 percent of the average daily wage , depending on the area of the country .
The economic data raises questions about who should be responsible for the costs of antibiotic treatment , given that more effective alternative antibiotic treatments are often inaccessible to the poor who also have no access to universal healthcare .
Six of the seven countries studied stated that the cost of antibiotics influenced which are prescribed . This is shown by the continued wide use of ampicillin and gentamicin , as they are consistently the most affordable antibiotics , despite having been long considered less effective than other antibiotic regimes .
GlobalHealthAsiaPacific . com OCTOBER 2021
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