Antibiotics for bacterial infections in children

Background: Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low- and middle-income countries (LMIC). Current guidelines for treating suspected sepsis within these limited healthcare-resource settings recommend hospitalisation and prophylactic intramuscular (IM) or intravenous (IV) ampicillin and gentamicin. These recommendations have not changed since 2005. In 2015, recommendations for patients for whom referral to hospital is not possible were published: they suggest the administration of IM gentamicin and oral amoxicillin. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for treating (suspected) sepsis (taking into account susceptibility patterns, cost and the risk of adverse events) in neonates and children is necessary. Methods: A systematic literature search was conducted to identify current published clinical evidence regarding the treatment of (suspected) sepsis, and international guidelines were also reviewed. Results: Five adequately designed and powered studies comparing antibiotic treatments in a low-risk community in neonates and young infants in LMIC were identified. The studies addressed potential simplifications of the current WHO treatment of reference, in particular for infants for whom admission to inpatient care was not acceptable or possible. There is a lack of current research regarding the clinical treatment of suspected sepsis in neonates and children with hospital-acquired sepsis, despite rising antimicrobial resistance rates worldwide. Conclusions: Current WHO guidelines supporting the use of gentamicin and penicillin for hospital-based patients or gentamicin (IM) and amoxicillin (oral) when referral is not possible accord with currently available evidence and other international guidelines, and there is no strong evidence to change this. The benefit of a cephalosporin alone or in combination as a second-line therapy in regions with known high rates of non-susceptibility is not well established. Further research into hospital-acquired sepsis in neonates and children is required.