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Improving the treatment of newborn babies with life-threatening sepsis

Coen van Hasselt’s pharmacology group collaborated on a study recently published in the renowned Lancet Infectious Diseases. The international team mapped the antibiotic treatment of the life-threatening inflammatory reaction sepsis in newborn babies. They did this for low- and middle-income countries, hoping to improve the treatment.

Sepsis is a life-threatening inflammatory reaction caused by bacterial infections. It is a major cause of infant mortality in newborns, particularly in low- and middle-income countries.

Large-scale studies lacking

Coen van Hasselt's group from the Leiden Academic Centre for Drug Research was involved in the large international collaboration BARNARDS. The researchers better mapped the antibiotic treatment of sepsis in newborns, with the ultimate aim of improving treatment. Van Hasselt: ‘Although there have been several large-scale studies in Europe and the US on the treatment of neonatal sepsis, there were no such large-scale studies for low- and middle-income countries.’

Coen van Hasselt: ‘Very inspiring to contribute to such a large-scale collaboration’

World Health Organization's advice not optimal

In the study, the team examined a large group of newborns in various low- and middle-income countries. In addition, the researchers looked at possible causes that could influence the success of antibiotic therapy in neonatal sepsis. They carefully mapped three aspects: the health status of the patients, the antibiotic therapy used and the characteristics of the bacteria found to cause sepsis.

Van Hasselt: ‘In many low- and middle-income countries, we see that antibiotic resistance is really a huge problem for proper treatment. For example, in this study we found that an antibiotic therapy that the World Health Organization recommends is probably not optimal. It concerns treatment with the drug ampicillin-gentamicin.’

Practical reasons stand in the way of success

Van Hasselt and PhD candidate Feiyan Liu used mathematical models to investigate which of the antibiotic treatments has the best chance of success.  Van Hasselt: ‘There were large differences between countries in terms of the antibiotics used and the degree of antibiotic resistance. And so the success of treatment also varied. Practical reasons play an important role here, such as the shelf life of the medicine, but also the cost of the treatment, which patients often have to pay themselves.’

Advice for other treatments

Based on this study, the team suggests alternative treatment strategies that may be more effective in treating sepsis in babies. The researchers took into account not only the degree of resistance but also the availability and cost of drugs. Further research is needed, they say in the paper.

‘It was very inspiring to contribute to such a large-scale international collaboration and we hope that this study can help to make progress in the treatment of sepsis in babies,’ Van Hasselt concludes. 

Kathryn M Thomson et al. Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS), Lancet Infectious Diseases (9 August, 2021)

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