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Simplified Treatment of Possible Severe Bacterial Infection in Young Infants When Referral Is Not Feasible. What Happened There? What Are the Implications Here?

Hodgins, Stephen, MD, MSc, DrPH

The Pediatric Infectious Disease Journal: December 2018 - Volume 37 - Issue 12 - p 1299–1302
doi: 10.1097/INF.0000000000002008
Maternal-Neonatal Reports

Severe bacterial infections remain one of the 3 leading causes of newborn death worldwide. Most such deaths could be prevented with timely and appropriate antibiotic treatment. However, in low-income countries, there are many such cases for which, practically speaking, it is not currently feasible to offer gold-standard, inpatient treatment with 7 days of parenteral antibiotics. Recent trial results, however, provide evidence for efficacy using simpler outpatient antibiotic regimens, equivalent to treatment with 7 days of procaine penicillin and gentamicin, given on an outpatient basis. Based on these findings, the World Health Organization has recently released guidelines endorsing such an approach for cases for which referral for inpatient treatment is not feasible. This brief report looks beyond the measured effect sizes in the published trials to other details on how they were implemented and what outcomes were observed for different groups of study participants. The report considers, further, the circumstances in country settings where such a strategy may be appropriate and offers issues for consideration by policy makers.

From the School of Public Health, University of Alberta, Edmonton, Alberta, Canada.

Accepted for publication October 31, 2017.

At the time the original article was submitted, the author was employed by Save the Children. No special funding was used to support writing of this article.

The author has no conflicts of interest to disclose.

Address for correspondence: Stephen Hodgins, MD, MSc, DrPH, School of Public Health, University of Alberta, 3–305 Edmonton Clinic Health Academy, 11405–87 Ave, Edmonton, AB T6G 1C9, Canada. E-mail:

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