Imagine a world in which we could stop antibiotics after one dose.

I came across an article from the BBC about a company in Israel that has developed a kit which can determine the presence of bacteria or virus in the blood of a patient within a two-hour window.  More than that the kit has a point of care device as shown below.

Imagine for a moment the impact of being able to determine the presence or absence of sepsis within a two-hour window.  Infants who have respiratory distress with a plan to assess in four-hours to determine need for antibiotics would never receive a dose.  Other infants who were given one dose of ampicillin and gentamicin at birth would not need any further doses if the test indicated no bacteria or viruses present.  Now you might say what is the harm in providing 48 hours of antibiotics or even 5 days if you are unsure of the presence of sepsis? There probably is little harm in a couple of days but the practice of prolonging antibiotics for fear that a patient has suspected sepsis is quite common in Neonatal circles.  A recent article by Greenwood C et al (http://1.usa.gov/1Ex4qlH) examined stools at 1, 2 and 3 weeks of premature infants exposed to either short 1-4 day or longer 5-7 day courses of antibiotics.  The results were quite striking in that the neonates exposed to the longer duration experienced less bacterial diversity than the other group and a preponderance of Enterobacter. Curiously levels of Lactobacillus and Bifidobacteria were low in all groups which might suggest a role for probiotics or explain why they might have been shown to reduce NEC.  In fact in this study higher rates of NEC, sepsis and death were noted in the group receiving prolonged courses!

I have written other posts in which I have commented on Probiotics so to be clear I am not advocating that we use them routinely but one does have to wonder if it would be worthwhile repopulating the intestine of an infant who legitimately needed a 7 day course for a proven infection.  Perhaps this post will stimulate someone to do that very study.

Aside from the perturbed microbiome leading to NEC, sepsis and death we also now have evidence of many long-term effects from antibiotics.  The one creating the most alarm in press is no doubt the emergence of “superbugs” but more recently evidence has started to mount that repeated courses of antibiotics in infancy may lead to adult obesity (http://bit.ly/18JIIj7) and childhood allergy (http://bit.ly/1LwBmBc).

Getting back to this new technology it would still seem to be in the early stages.  Looking through the company’s website they are allowing people to apply to be an early adopter.  Additionally the links to their publications are really presentations at this time.  A Pubmed search failed to come up with any specific articles regarding these products to I would have to say we are still in this products infancy.  That being said it is certainly exciting to speculate about the impact that this innovation could have especially the point of care device pictured above which would bring the diagnosis to the bedside!  I would encourage you to look at MeMeds website as it has a lot of very good information and if you check in from time to time who knows, you might be the first to hear that the two-hour test for sepsis is ready for use in your unit somewhere.

MeMed

http://www.me-med.com/html5/sbs.py?_id=11045&did=2466&G=2466

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3 thoughts on “Imagine a world in which we could stop antibiotics after one dose.

  1. This is truly exciting and could revolutionize how we treat neonates in the NICU. As we are all aware, sepsis in the newborn comes in many disguises and manifests in such a variety of ways that it is almost knee jerk to treat with antibiotics if a baby responds atypically at birth. We’ve historically thought that a 48 hr rule out with antibiotics was safe but science is now showing us that there are long term consequences to treating even for a short period of time. A tool such as this one, if proven to be accurate, could potentially help alleviate those risks. We will have to monitor to see if it does make a difference in the long term by treating with one dose of antibiotics vs 4 or more if we choose to adopt this tool for use in our units.

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