Antibiotics for childhood meningitis and sepsis are increasingly ineffective
Data from southeast Asia and the Pacific highlight the growing threat posed by antibiotic-resistant bacteria.
- 3 November 2023
- 3 min read
- by Linda Geddes
Several antibiotics recommended to treat serious childhood bacterial infections are now less than 50% effective in areas of southeast Asia and the Pacific, data suggests.
The finding adds to mounting evidence about the scale of antimicrobial resistance (AMR) and suggests that global guidelines on antibiotic use may need to be updated.
Antibiotics are the mainstay of treatment for life-threatening sepsis and meningitis in newborn infants and children. However, the detection of high levels of resistance to some of these drugs is a considerable worry – particularly in lower income settings where access to alternative antibiotics is limited.
“Antibiotic resistance is rising more rapidly than we realise. We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year.”
– Dr Phoebe Williams, University of Sydney and Sydney Infectious Diseases Institute, Australia
"In [newborn children] alone, an estimated three million cases of sepsis occur each year, resulting in up to 570,000 sepsis-attributable deaths – many of which are due to resistance to currently recommended and available antibiotics," said Dr Phoebe Williams at the University of Sydney and Sydney Infectious Diseases Institute in Australia.
To better understand how AMR is affecting the treatment of serious childhood bacterial infections in lower- and middle-income countries in southeast Asia and the Pacific, Williams and colleagues scrutinised data from 86 scientific studies incorporating 6,648 bacterial samples collected across 11 countries.
The study, published in The Lancet Regional Health – Southeast Asia, found that the coverage provided by aminopenicillins, gentamicin and third generation cephalosporins (e.g. ceftriaxone and cefotaxime) – antibiotics that the World Health Organization currently recommends as first-line therapy for treating sepsis and meningitis in children and newborns – was low.
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Aminopenicillin and third generation cephalosporins were likely to be effective in treating less than one in three cases of sepsis or meningitis in newborn babies (26% and 29%), while the coverage provided by gentamicin was only 45%.
For childhood sepsis, the coverage provided by these drugs ranged from 37–51%, while for childhood meningitis coverage was 62% and 65% for third generation cephalosporins and aminopenicillin, but just 21% for gentamicin.
Carbapenems provided higher rates of coverage, ranging from 79% to 81%, yet their widespread use needs to be balanced against propagating further AMR, particularly carbapenem-resistant infections, the authors said.
"Whilst we wish to emphasise that our approach is exploratory and amounts to a first approximation, these data call into urgent question the adequacy of coverage currently provided by WHO-recommended first- and second-line antibiotic regimens," they added.
They called for an evaluation of alternative antibiotic regimens targeted to local pathogen and resistance patterns, and for the optimisation of antimicrobial stewardship to counter the growing threat posed by AMR.
"Antibiotic resistance is rising more rapidly than we realise. We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year," said Williams, who is working with the WHO's Paediatric Drug Optimisation Committee to ensure children have access to antibiotics to treat multidrug-resistant infections as soon as possible.
She added that the best way to tackle antibiotic resistance in childhood infections would be to prioritise funding to investigate new antibiotic treatments for children and newborns.