The World Health Organization (WHO) recommends ampicillin (or penicillin) plus gentamicin for empirical treatment of suspected sepsis in neonates and infants <2 months old in developing countries. A systematic review of 19 studies from 13 countries found that Staphylococcus aureus and Gram-negative bacilli (mostly Escherichia coli and Klebsiella species) caused more than half of the >4000 positive blood cultures. The WHO regimen covered only 57% of isolates, but third-generation cephalosporins that covered 56% fared no better. The authors called for revised recommendations. An accompanying editorial subtitled ‘The War on Error’ said there was as much chance of combating antibiotic resistance by escalation as of winning the war on terror. The editorial writers advocated de-escalation of broad-spectrum antibiotic use, improved diagnostics and prevention of neonatal infections.
Reviewer: David Isaacs, firstname.lastname@example.org