New evidence shows that treating severe infections closer to home with fewer antibiotic injections could save lives by increasing access to care when hospitalization is not possible.
Giving antibiotic regimens with fewer injections to newborns with severe infections in lower income countries is as effective as the standard course of twice daily injections over the course of a week, according to research conducted in Bangladesh, Nigeria, Kenya, and Democratic Republic of Congo. The promising new evidence published in The Lancet and The Lancet Global Health on April 2, shows a safe, effective and simpler treatment for severe infections can be provided in lower level facilities when access to hospitalization is not possible. If implemented at scale, a significant portion of the 629,000 annual newborn deaths due to infection could be prevented.
The current standard of treatment for severe infections requires in-patient care and a 7-day treatment. This poses significant barriers for families across the world, especially in developing settings where serious financial or logistical challenges limit access to a hospital. This leaves thousands of children at risk of not receiving proper care.
The study in Asia tested two alternative antibiotic regimens, combining injectable and oral administration of the drugs. The studies in Africa tested the same two alternatives plus a third even simpler treatment compared to the standard WHO treatment of 14 injections over 7 days. The simplest alternative treatment included only two days of injectable antibiotic with oral treatment followed by five days of oral antibiotics only.
The studies show that when hospitalization is not possible, simpler antibiotic treatment can be provided in lower level facilities and be as effective and safe as the current standard of treatment. They also documented that families were able to correctly give the necessary oral antibiotics at home when given proper instruction from health care providers. The studies demonstrated the need for appropriate follow up and monitoring by trained health workers for this strategy to be safe and effective.
By improving access to effective and available treatment, this new regimen promises to save thousands of newborn lives with low cost, effective and commonly available antibiotics. The antibiotics tested in the study — penicillin, amoxicillin, and gentamicin are listed by the UN Commission on Life-Saving Commodities for Women and Children as high-impact commodities that, if scaled up, can significantly reduce preventable deaths.
The research was funded by the Bill & Melinda Gates Foundation, Save the Children, USAID, and WHO, in collaboration with the Johns Hopkins Bloomberg School of Public Health and researchers in Nigeria, Bangladesh, D.R. Congo, and Pakistan. Photos: Bangladesh – CJ Clarke/Save the Children; Kenya – Colin Crowley/Save the Children.