Rethinking management of neonates at risk of sepsis

Exposure to broad-spectrum antibiotics alters the body's microbiota, increases opportunistic infections, and promotes antimicrobial resistance (AMR), which may restrict future treatment options for the child.1 Therefore, a contextual evaluation of risks and benefits is necessary when prescribing antibiotics. Scarce epidemiological data in these places complicate the application of knowledge.8,9 Comorbidities, including prematurity, malnutrition, micronutrient deficiencies, and maternal HIV infection, can compromise postnatal immunological adaptation and thus increase the risk of sepsis.10 Yet one study in south Asia suggested that most cases of sepsis in young children could have had non-bacterial causes, although these findings require confirmation.11 Although we cannot reject that the benefits of prescribing antibiotics in these settings could outweigh the risks, we are open to the possibility that the opposite might be true and this is worthy of investigation. [...]diagnostic tests are often unavailable in these settings, thus antibiotics can be started without measures to inform cessation of therapy. [...]access to existing laboratory tests for diagnosing sepsis (eg, procalcitonin, C-reactive protein) need to be facilitated, and next-generation diagnostic tests that are fast, reliable, and widely accessible need to be developed to address the limitations of the current reference standard blood culture that is insensitive and prone to contamination, especially in resource-poor settings.