A Systemic review of Effectiveness of Antibiotic Treatments for Sepsis or Potential Serious Bacterial Infections in Infants Aged 0 to 59 Days

Sepsis is one of theprominent causes for morbidity and mortality in young infants worldwide, impacting 6.3 million newborns in 2019 and leading to approximately 200,000 neonatal deaths each year.Sepsis is a syndrometypified by abnormal clinical and laboratory findings, resulting from systemic inflammation in the presence of a known or suspected infection. 

The standard method for diagnosing sepsis is detecting the growth of pathogens in a blood culture. However, in absence of blood cultures, the World Health Organization (WHO) has established various criteria and clinical guidelines for identifying possible serious bacterial infections (PSBI) based on infant examination, medical history, and vital signs.

This study is aimed to assess the effectiveness of different antibiotic treatments for treating sepsis or PSBI in young infants and its impact on clinical outcomes.The study gathered data from various sources including MEDLINE, Embase, CINAHL, World Health Organization Global Index Medicus, and Cochrane Central Registry of Trials.

It included 41 randomized controlled trials (RCTs) involving young infants aged 0 to 59 days with sepsis or PSBI, comparing different antibiotic treatments to evaluate their effectiveness on clinical outcomes.

Among the included RCTs, 35 trials were hospital-based and 6 were nonhospital-based. The results demonstrated that the meta-analysis of 4 trials showedcomparable rates of treatment success with intramuscular/intravenous third generation cephalosporins and intramuscular/intravenous penicillin or ampicillin + gentamicin (RR 1.03, 95% CI 0.93–1.13). While meta-analysis of 3 trials revealedequal rates of treatment failure with oral amoxicillin + intramuscular gentamicin and intramuscular penicillin + gentamicin for nonhospital management of clinical severe illness (RR 0.86, 95% CI 0.72–1.02). 

To conclude, there is limited evidencethat indicatedWHO's recommended first- or second-choice antibiotic regimens are comparable to or possibly better than other alternatives, with many estimates being uncertain. The studies conducted in both hospital and non-hospital settings showed variations in interventions, making it difficult to combine the results. Considering the evolving global landscape of sepsis and antimicrobial resistance patterns, our review highlights the importance of conducting well-designed trials to guide policies on antibiotic treatment recommendations for young infants with sepsis or PSBI.

Source: North K, Mathias S, Schmeck N, Kim Y, Kehoe T, Folger LV, Hoey A, Wade C, Driker S, Chou R, Edmond KM, Lee AC. Efficacy of Antibiotic Regimens for Sepsis or Possible Serious Bacterial Infection in Young Infants Aged 0 to 59 Days: A Systematic Review and Meta-analysis. Pediatrics. 2024 Aug 1;154(Suppl 1):e2024066588F. doi: 10.1542/peds.2024-066588F. PMID: 39087801.