Ongoing trials of simplified antibiotic regimens for the treatment of serious infections in young infants in South Asia and sub-Saharan Africa: implications for policy.
BACKGROUND
The current World Health Organization (WHO) recommendation for treatment of severe infection in young infants is hospitalization and parenteral antibiotic therapy. Hospital care is generally not available outside large cities in low- and middle-income countries and even when available is not acceptable or affordable for many families. Previous research in Bangladesh and India demonstrated that treatment outside hospitals may be possible.


METHODS
A set of research studies with common protocols testing simplified antibiotic regimens that can be provided at the lowest-level health-care facility or at home are nearing completion. The studies are large individually randomized controlled trials that are set up in the context of a program, which provides home visits by community health workers to detect serious illness in young infants with assessment and treatment at an outpatient health facility near home. This article summarizes the policy implications of the research studies.


CONCLUSIONS
The studies are expected to result in information that would inform WHO guidelines on simple, safe and effective regimens for the treatment of clinical severe infection and pneumonia in newborns and young infants in settings where referral is not possible. The studies will also inform the inputs and process required to establish outpatient treatment of newborn and young infant infections at health facilities near the home. We expect that the information from research and the resulting WHO guidelines will form the basis of policy dialogue by a large number of stakeholders at the country level to implement outpatient treatment of neonatal infections and thereby reduce neonatal and infant mortality resulting from infection.
Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya.
Fabian
F
Esamai
Antoinette Kitoto
AK
Tshefu
Adejumoke I
AI
Ayede
Ebunoluwa A
EA
Adejuyigbe
Robinson D
RD
Wammanda
Abdullah H
AH
Baqui
Anita K M
AK
Zaidi
Samir
S
Saha
Nigel Campbell
NC
Rollins
Stephen
S
Wall
Neal
N
Brandes
Cyril
C
Engmann
Gary
G
Darmstadt
Shamim Ahmad
SA
Qazi
Rajiv
R
Bahl
D017954:Africa South of the Sahara; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001459:Bangladesh; D002986:Clinical Trials as Topic; D003153:Community Health Services / Q000379:methods*; D016638:Critical Illness; D003695:Delivery of Health Care; D004334:Drug Administration Schedule; D006291:Health Policy; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D018805:Sepsis / Q000188:drug therapy*; D014944:World Health Organization
D000900:Anti-Bacterial Agents