Alarming resistance rates prompt calls for updated antibiotic guidelines

Drugs to treat common infections in children and babies are no longer effective in large parts of the world, due to alarmingly high rates of bacterial resistance, reveals new research.

The University of Sydney led study found many antibiotics recommended by the World Health Organization (WHO) had less than 50% effectiveness in treating childhood infections such as pneumonia, sepsis (bloodstream infections) and meningitis.

The study analysed 6648 bacterial isolates from 11 countries across 86 publications to review antibiotic susceptibility for common bacteria causing childhood infections.

The most seriously affected regions are in South-East Asia and the Pacific — including neighbouring Indonesia and the Philippines, where thousands of unnecessary deaths in children resulting from antibiotic resistance occur each year.

In newborns, an estimated three million cases of sepsis occur globally each year, with up to 570,000 deaths: many of these are due to a lack of effective antibiotics to treat resistant bacteria.

The findings show global guidelines on antibiotic use are outdated, revealing an urgent need for updates to reflect the rapidly evolving rates of antimicrobial resistance (AMR). The most recent guideline from The World Health Organization was published in 2013.

A wake-up call

Australia is not immune to the problem — the burden of antimicrobial resistance is on our doorstep, said lead author and infectious disease specialist Dr Phoebe Williams from the University’s School of Public Health, whose research focuses on reducing AMR in high-burden healthcare settings in Southeast Asia.

She also works as a clinician in Australia. Williams said there are increasing cases of multidrug-resistant bacterial infections in children around the world.

AMR is more problematic for children than adults, as new antibiotics are less likely to be trialled on, and made available to, children. Williams said the study should be a wake-up call for the whole world, including Australia.

“Antibiotic resistance is rising more rapidly than we realise. We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year.”

Williams said the best way to tackle antibiotic resistance in childhood infections is to make funding to investigate new antibiotic treatments for children and newborns a priority.

AMR among children

Williams is working with the WHO’s Paediatric Drug Optimisation Committee to ensure children have access to antibiotics to treat multidrug-resistant infections as soon as possible, to reduce deaths due to AMR among children.

“Antibiotic clinical focus on adults, and too often children and newborns are left out. That means we have very limited options and data for new treatments.”

She is currently looking into an old antibiotic, fosfomycin, as a temporary lifeline to treat multidrug-resistant urinary tract infections in children in Australia.

“This study reveals important problems regarding the availability of effective antibiotics to treat serious infections in children,” said senior author Paul Turner, Director of the Cambodia Oxford Medical Research Unit at Angkor Hospital for Children, Siem Reap and Professor of Paediatric Microbiology at the University of Oxford, UK.

“It also highlights the ongoing need for high-quality laboratory data to monitor the AMR situation, which will facilitate timely changes to be made to treatment guidelines.”

Ceftriaxone and gentamicin

The study found one antibiotic in particular, ceftriaxone, was likely to be effective in treating only one in three cases of sepsis or meningitis in newborn babies. Ceftriaxone is also widely used in Australia to treat many infections in children, such as pneumonia and urinary tract infections.

Another antibiotic, gentamicin, was found likely to be effective in treating fewer than half of all sepsis and meningitis cases in children.

Gentamicin is commonly prescribed alongside aminopenicillins, which the study showed also has low effectiveness in combating bloodstream infections in babies and children.

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