Abstract
Multidrug-resistant bacterial infection is a global phenomenon and newborn units are not spared. Judicious use of antibiotics is one of the measures employed to curb the emergence of multidrug-resistant bacteria. It entails the use of empiric antibiotics based on knowledge of prevailing pathogens and antibiotic susceptibility patterns while awaiting the results of cultures. This retrospective review of records of 170 outborn neonates treated at the emergency room of the University College Hospital (UCH), Ibadan sought to determine indications for antibiotic therapy, the available supporting investigations and factors militating against the judicious use of antibiotics in newborns. The median age at presentation was three days. The majority (91.2%) were commenced on antibiotics on admission without any prior laboratory investigations. The indications for antibiotics were based on clinical signs only in 48% of cases, risk factors for sepsis with clinical signs in 42% of cases and no apparent reason in 6.8%. Lack of funds and logistic problems with the laboratory were the reasons for not conducting investigations before the commencement of antibiotics in 49.4% and 15.3% of cases respectively. Full blood count was eventually done in 32.9% of which a third were consistent with sepsis. Blood cultures were eventually done in 33.5% and positive in 5.3% of cases. Majority of newborns had empiric antibiotic therapy without the necessary laboratory back up due largely to financial constraints and other logistic issues with the laboratory. Inappropriate use of antibiotics in terms of initiation of empiric treatment, choice of drugs and failure to investigate as necessary was common.
Highlights
Neonatal infections remain a major cause of neonatal mortality in developing countries, its clinical signs are subtle and nonspecific but with severe consequences. [1,2,3,4] In view of the negative impact of infections on mortality and long term outcomes, empirical antibiotics are usually administered to symptomatic newborns or those at high risk of sepsis while awaiting culture results, with subsequent continuation or discontinuation guided by of culture and sensitivity results
Judicious use of antibiotics refers to the use of antibiotics in a manner that will eradicate bacteria, optimize treatment by diagnosis and severity assessment taking into cognizance the prevalence of local resistance, pharmacokinetics and pharmacodynamics, dosage, efficacy and cost effectiveness
Neonatal sepsis can be rapidly fatal it is standard practice to commence empiric antibiotic therapy in suspected cases, after prompt sepsis screening while awaiting results of investigations in order to prevent fatality
Summary
Neonatal infections remain a major cause of neonatal mortality in developing countries, its clinical signs are subtle and nonspecific but with severe consequences. [1,2,3,4] In view of the negative impact of infections on mortality and long term outcomes, empirical antibiotics are usually administered to symptomatic newborns or those at high risk of sepsis while awaiting culture results, with subsequent continuation or discontinuation guided by of culture and sensitivity results. [5] The indiscriminate and prolonged use of broad-spectrum antibiotics (especially 3rd generation cephalosporins) in newborns has been associated with necrotizing enterocolitis, late-onset sepsis and invasive candidiasis. [6] The menace of multidrugresistant bacteria has been of great public health concern globally, in developing countries [2, 7], yet the prospect of new classes of antibiotics emerging soon is slim [8]. Neonatal infections remain a major cause of neonatal mortality in developing countries, its clinical signs are subtle and nonspecific but with severe consequences. [5] The indiscriminate and prolonged use of broad-spectrum antibiotics (especially 3rd generation cephalosporins) in newborns has been associated with necrotizing enterocolitis, late-onset sepsis and invasive candidiasis. [6] The menace of multidrugresistant bacteria has been of great public health concern globally, in developing countries [2, 7], yet the prospect of new classes of antibiotics emerging soon is slim [8]. The unrestricted use of broad-spectrum antibiotics is reported to be a contributory factor to the emergence of drug resistance. Judicious use of antibiotics refers to the use of antibiotics in a manner that will eradicate bacteria, optimize treatment by diagnosis and severity assessment taking into cognizance the prevalence of local resistance, pharmacokinetics and pharmacodynamics, dosage, efficacy and cost effectiveness. [9] It is one of the control measures required in the newborn unit to curb the emergence of multidrug-resistant bacteria
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