Children May Be Given Unnecessary Antibiotics to Prevent Early Onset Neonatal Sepsis: Study

While early onset sepsis can be fatal, doctors may be contributing to antibiotic overuse and the evolution of resistant superbugs by giving it to children at low or no risk.

Despite global concerns about the long-term effects of antibiotic overuse, the findings of a new study suggests that infants are often prescribed the drugs even when there is little to no risk of developing early onset sepsis.

Early onset neonatal sepsis is a complex illness impacting infants, which occurs after exposure to bacteria during birth. The infections can evolve rapidly in the first 72 hours after birth and can be fatal, even after antibiotics have been administered.

In a report published this month in the medical journal Pediatrics, researchers with the Children’s Hospital of Philadelphia Newborn Care report that more than 80% of newborns at low risk for developing early onset sepsis and 91% of infants considered to have no risk were given antibiotics to combat the infections, resulting in unnecessary use of the medications.

Overuse of antibiotics has become a serious concern in the medical community, potentially leading to the development of “superbug” infections that are resistant to available medications and difficult to treat.

Prior research has found that low-birth-weight infants considered at low risk for early onset sepsis can be given antibiotics without serious risks, leading many doctors tending to err on the side of caution and give infants antibiotics after birth. However, in this latest study, researchers warn that a substantial proportion of this antibiotics administered are unnecessary, urging doctors to exercise more caution in deciding whether to use the drugs.

The study focused on infants born 2009 to 2014, with blood cultures with or without cerebrospinal fluid culture obtained more than 72 hours after birth. Low early onset sepsis risk was determined if mothers had a cesarean delivery, their water did not break before delivery, or there was no concern regarding intra-amniotic infection.

Nearly 54,000 births were included in the study, but only 7,549 infants were evaluated. Of the infants evaluated, 0.5% had early onset sepsis. This translates to only 41 infants developing early onset sepsis out of the 7,500 infants assessed. However, low-risk delivery characteristics were present for about 15% of the infants overall, or about 1,100 newborns, but none of them had early onset sepsis.

Among the newborns, doctors administered antibiotics to 80% of infants born with low-risk characteristics and 91% of infants born without low-risk characteristics. In both groups, despite the presence or lack of characteristics, doctors administered antibiotics to a majority of infants.

The duration antibiotics were administered to infants born with and without low-risk characteristics did not differ. Doctors largely did not distinguish between low-risk infants and infants with no risk when giving antibiotics.

Applying risk assessments to newborns may help to reduce courses of antibiotics given to infants, the researchers concluded. Offering antibiotics only to infants with risk assessment of early onset sepsis and not to those that don’t meet the criteria could reduce how frequently newborns are taking antibiotics.

“Risk of early onset sepsis among infants with low-risk delivery characteristics is extremely low,” wrote study authors. “Despite this, a substantial proportion of these infants are administered antibiotics. Delivery characteristics should inform empirical antibiotic management decisions among infants born at all gestational ages.”

Health experts say the unnecessary use of the medications contributes to the proliferation of antibiotic resistant bacteria. Previous research has warned that antibiotic-resistant bacteria could kill more than 10 million people every year by 2050 if measures are not implemented to reduce unnecessary prescribing.

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