Sepsis is responsible for a significant burden of disease in neonates and young infants, both as a primary cause of death and as a frequent contributor [1,2]. Access to facility-based delivery and care, including antibiotics, has not reduced mortality sufficiently to achieve the Sustainable Development Goal targets in many low- and middle-income countries (LMICs) [3]. Antimicrobial resistance (AMR) increasingly threatens to undermine the effectiveness of antibiotics and potentially slow progress in reducing mortality, particularly in LMICs [4–10], with AMR-attributable neonatal deaths recently estimated between 140,000 [10] and 214,000 annually [11].
Recent large-scale antibiotic trials in neonates and young infants in LMIC settings have largely focused on simplification of first-line antibiotic regimens with oral amoxicillin and short course gentamicin [12,13]. These have been based in primary healthcare settings and included populations with case fatality below 2%. An increasing global proportion of newborns are delivered in facilities [14], where sepsis case fatality rates and the burden of AMR are greater. Despite this, there is limited high-quality evidence generated from LMIC neonatal inpatient settings to guide empiric antibiotic treatment [4,15]. Published observational data largely involve single-center studies reporting non-systematically collected microbiological data, which are rarely accompanied by detailed clinical and antibiotic use data. Data regarding global antibiotic use often rely on point prevalence surveys, with limited information on patterns of switching and duration [16].
Authors
Neal J. Russell, Wolfgang Stöhr, Nishad Plakkal, Aislinn Cook, James A. Berkley, Bethou Adhisivam, Ramesh Agarwal, Nawshad Uddin Ahmed, Manica Balasegaram, Daynia Ballot, Adrie Bekker, Eitan Naaman Berezin, Davide Bilardi, Suppawat Boonkasidecha, Cristina G. Carvalheiro, Neema Chami, Suman Chaurasia, Sara Chiurchiu, Viviane Rinaldi Favarin Colas, Simon Cousens, Tim R. Cressey, Ana Carolina Dantas de Assis, Tran Minh Dien, Yijun Ding,Nguyen Trong Dung, Han Dong, Angela Dramowski, Madhusudhan DS, Ajay Dudeja, Jinxing Feng, Youri Glupczynski, Srishti Goel, Herman Goossens, Doan Thi Huong Hao, Mahmudul Islam Khan, Tatiana Munera Huertas, Mohammad Shahidul Islam, Daniel Jarovsky, Nathalie Khavessian, Meera Khorana, Angeliki Kontou, Tomislav Kostyanev, Premsak Laoyookhon, Sorasak Lochindarat, Mattias Larsson, Maia De Luca, Surbhi Malhotra-Kumar, Nivedita Mondal, Nitu Mundhra, Philippa Musoke, Marisa M. Mussi-Pinhata,Ruchi Nanavati, Firdose Nakwa, Sushma Nangia, Jolly Nankunda, Alessandra Nardone, Borna Nyaoke, Christina W. Obiero, Maxensia Owor, Wang Ping, Kanchana Preedisripipat, Shamim Qazi ,Lifeng Qi, Tanusha Ramdin, Amy Riddell, Lorenza Romani, Praewpan Roysuwan,Robin Saggers, Emmanuel Roilides, Samir K. Saha, Kosmas Sarafidis, Valerie Tusubira, Reenu Thomas, Sithembiso Velaphi, Tuba Vilken, Xiaojiao Wang, Yajuan Wang, Yonghong Yang, Liu Zunjie, Sally Ellis, Julia A. Bielicki, A. Sarah Walker, Paul T. Heath, Mike Sharland