Interview with Dr Jolly Nankunda: Neonatal observational study shows the need to develop new antibiotics

Dr Jolly Nankunda is the Principal Investigator (PI) for the NeoOBS Study and Senior Consultant Pediatrician/Neonatology in Uganda. She highlights the challenges faced by neonates due to incorrect use of antibiotics and what the study aims to improve.

Every child deserves to live a quality and healthy life. But this is not always the case as children are prone to pick up various infections either during pregnancy, at birth or in the early years of infancy. Neonatal sepsis is one such infection. In Uganda it is one of the top three killers of neonates (babies aged 0 up to 28 days of life). The infection is usually transmitted through unhygienic delivery facilities, births handled by unskilled health workers, traditional birth practices, poor umbilical cord care, sick expectant mothers to their child during delivery.

The first line of treatment in tackling sepsis which is a bacterial or fungal infection includes broad-spectrum intravenous antibiotic therapy. Often, antibiotics are misused either through incorrect dosage or administration for the wrong disease. In other instances, those who are infected cannot access the required antibiotics due to shortage. When a child receives the wrong treatment because they are improperly diagnosed, they will continue to suffer from recurrent health issues over the years.

“Children ought to be given antibiotics when they need them. It is frustrating to see a child who has been unwell, received antibiotics and they are not working,” says Dr Jolly Nankunda, Principal Investigator for the Neonatal Observational Study (NeoOBS) and Senior Consultant Pediatrician/Neonatology in Uganda. “I also get disappointed when I see a child being given many different antibiotics and this motivates me to be part of the journey,” she added.

As the PI for the NeoOBS study in Kampala, she oversaw the study which targeted 200 babies with suspected neonatal sepsis in Mulago National Referral hospital and Mulago Specialized Women and Neonatal hospital. The study was purely observational in checking on the clinical practices and handling of the babies suspected to have neonatal sepsis. The objective of the study was to observe how antibiotics are currently being used and inform the design of trials to evaluate improved treatment options for neonatal sepsis and develop tools that can be used to improve the care on neonates with sepsis.

Over 3,200 babies with clinically diagnosed sepsis in 11 countries were included in one of the largest observational studies on neonatal sepsis, which was carried out by GARDP and partners in 2019 and 2020. However, it was only possible to identify the bacteria causing the infection in 20% of those babies. The most common bacteria identified was Klebsiella pneumoniae which causes infections that are resistant to antibiotics.

Unfortunately, it is often not possible to identify exactly what bacteria causes infections, and in babies this is even harder. Other previously uncommon organisms were detected which means there are evolving organisms that cause infections in babies. Initial results from the study are instrumental in increasing their alertness in detecting organisms that were not previously common. The presence of different spectrum of organisms means there is need to review treatment guidelines nationally and globally.

The NeoOBS study will inform an upcoming neonatal sepsis clinical trial which will enrol 3,000 babies, including in Kenya and South Africa. It will obtain robust evidence of the safety and efficacy of new antibiotic combinations compared to the WHO-recommended regimen and existing antibiotic combinations for the treatment of neonatal sepsis.

Antibiotic resistance has been common in ICU care for neonates and adults where patients require a higher spectrum and dosage to treat bacteria.

“This becomes costly and not within the essential drug list provided by the Ministry of Health thus leading to inconsistent use of antibiotics. Those prescribing these drugs need to exercise caution and be strict on how antibiotic resistance can be curbed,” she added.

Given the changing trends in the kind of organisms infecting small babies, there is a need to develop and test newer antibiotics to establish whether there will be better outcomes to treat neonatal sepsis. The threat of drug resistance is likely to increase in the coming years unless health regulators strengthen the control on the use and availability of antibiotics for the different conditions.

“Proper use of antibiotics needs to be enforced and encouraged in the health centres and pharmacies. Increasing facilities for conducting the culture tests will assist in prescribing the right medicines. Emphasis on preventive measures and awareness creation on healthy practices for expectant mothers will help in reducing exposure of babies to neonatal sepsis,” says Dr Nankunda.

According to the World Health Organization, neonatal sepsis can be prevented through access to quality care during pregnancy and childbirth, access to clean water and sanitation, proper infection control practices in hospitals and clinics, timely access to the right medicines and responsible regimen administration.