Title : Should we look beyond antibiotics while treating neonates with sepsis?
Abstract:
Sepsis is an important medical emergency among neonates affecting 15-20 infants per 1000 live births in low and middle-income countries. The mortality can be as high as 15-20% especially among pre-term and low birth weight babies. Antimicrobial resistance is an important issue that needs to be tackled. The restricted use of effective short spectrum antibiotics for the minimum number of days should be recommended. The maintenance of good hygienic practices and antibiotics stewardship are other measures to curtail infections and reduce antimicrobial resistance. Gram negative bacteria like E. coli, Klebsiella, Acinetobacter and Pseudomonas are responsible for mostof the neonatal infections. Among the Gram-positive organisms; Staph aureus, Streptococci, Enterobacter species are common. But the major issue is the non-specific presentation of sepsis among neonates and non-availability of reliable screening tests for early diagnosis. It is observed that there is variable individual susceptibility of neonates for infection. Global DNA methylation studies and infection related gene analysis showed that there is significant genetic difference between infants with infection and healthy controls. There is increase in inflammatory mediators at the initiation of infection process. As the disease advances, the surge in inflammatory mediators leads to organ damage and death. Use of Narciclasine, a plant anti-inflammatory alkaloid has been found to be beneficial in reducing the severity and better survival among sepsis induced neonatal rat model. Zinc is a micronutrient found to be beneficial in reducing susceptibility to infection among neonates. Moreover, it reduces duration and severity of diarrhea and respiratory infections among children. We observed reduction in mortality and morbidity among neonates with sepsis who received Zinc in addition to ntibiotics. One should be careful in avoiding administering Zinc in higher amounts since it can cause copper deficiency and other side effects.
