Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis

Abstract

The high rate of community-acquired resistant sepsis-especially that caused by Klebsiella spp. and S aureus-is a serious global public health concern. In vitro susceptibility data suggest that third-generation cephalosporins are not more effective in treating sepsis than the currently recommended antibiotics, benzylpenicillin and gentamicin; however, with either regimen a significant proportion of bacteraemia is not covered. Revised recommendations for effective second-line antibiotics in neonatal and infant sepsis in developing countries are urgently needed.

Characterisation of extended-spectrum β-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique

“…However, the emergence and widespread development of multidrug-resistant (MDR) strains to the early effective antibiotics led to the introduction of broadspectrum antibiotics such as fluoroquinolones or third-generation cephalosporins, which are often unaffordable or unavailable in most low-income countries [2]. Unfortunately, during the last three decades, extended-spectrum b-lactamases (ESBLs) produced by enteric pathogens have spread worldwide since their first description in 1983 [3].…”

“…Klebsiella pneumoniae is among the most clinically relevant Enterobacteraceae, being frequently reported as a cause of serious infections [3]. Moreover, an increase in the isolation of MDR strains, especially those producing ESBLs, has also been described [3].…”

“…Moreover, an increase in the isolation of MDR strains, especially those producing ESBLs, has also been described [3]. Infections caused by MDR K. pneumoniae strains have been associated with adverse clinical outcomes, including increased mortality, and prolonged hospitalisation associated with economic costs for the health system [8].…”

Pattern of Antibiotics Utilization in Neonatal Septicemia: A Cross-Sectional Study From Rural Tertiary Care Hospital Western Maharashtra, India

“…It is reported in previously published studies that use of third generation cephalosporins increases the risk of invasive candidiasis and death in low birth weight neonates (weight ≤1.5 kg) [21,22]. Studies also suggest that third-generation cephalosporins are not more effective in treating sepsis than benzylpenicillin and gentamicin [23]. Previous studies recommended cephalosporins to be used as second line drugs [24].…”

Stochastic Process Pharmacodynamics: Dose Timing in Neonatal Gentamicin Therapy as an Example

“…The approach takes into account drug-induced "adaptive resistance," which is reversible within days [reviewed in (4,10)]; it does not consider irreversible resistance caused, e.g., by bacterial mutations (11,12). It predicts standard intravenous injection dosing regimens may sometimes drive the average CFU number per patient to <1.…”