Less is more: Antibiotics at the beginning of life

Martin Stocker; Claus Klingenberg; Lars Navér; Viveka Nordberg; Alberto Berardi; Salhab El Helou; Gerhard Fusch; Joseph M Bliss; Dirk Lehnick; Varvara Dimopoulou; Nicholas Guerina; Joanna Seliga-Siwecka; Pierre Maton; Donatienne Lagae; Judit Mari; Jan Janota; Philipp K A Agyeman; Riccardo Pfister; Giuseppe Latorre; Gianfranco Maffei; Nichola Laforgia; Enikő Mózes; Ketil Størdal; Tobias Strunk; Eric Giannoni

doi:10.1038/s41467-023-38156-7

Less is more: Antibiotics at the beginning of life

Nat Commun. 2023 Apr 27;14(1):2423. doi: 10.1038/s41467-023-38156-7.

Authors

Martin Stocker¹, Claus Klingenberg^{2

3}, Lars Navér^{4

5}, Viveka Nordberg^{4

5}, Alberto Berardi⁶, Salhab El Helou⁷, Gerhard Fusch⁷, Joseph M Bliss⁸, Dirk Lehnick⁹, Varvara Dimopoulou¹⁰, Nicholas Guerina⁸, Joanna Seliga-Siwecka¹¹, Pierre Maton¹², Donatienne Lagae¹³, Judit Mari¹⁴, Jan Janota^{15

16}, Philipp K A Agyeman¹⁷, Riccardo Pfister¹⁸, Giuseppe Latorre¹⁹, Gianfranco Maffei²⁰, Nichola Laforgia²¹, Enikő Mózes²², Ketil Størdal²³, Tobias Strunk²⁴, Eric Giannoni¹⁰

Affiliations

¹ Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland. [email protected].
² Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
³ Dept. of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
⁴ Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
⁶ Neonatal Intensive Care Unit, Mother and Child Department, Policlinico University Hospital, Modena, Italy.
⁷ Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Canada.
⁸ Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Richmond, USA.
⁹ Biostatistics and Methodology, CTU-CS, Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
¹⁰ Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹¹ Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warszawa, Poland.
¹² Service néonatal, Clinique CHC-Montlegia, groupe santé CHC, Liège, Belgium.
¹³ Neonatology and Neonatal Intensive Care Unit, CHIREC-Delta Hospital, Brussels, Belgium.
¹⁴ Department of Paediatrics, University of Szeged, Szeged, Hungary.
¹⁵ Neonatal Unit, Department of Obstetrics and Gynecology, Motol University Hospital Prague, Prague, Czech Republic.
¹⁶ Department of Neonatology, Thomayer University Hospital Prague, Prague, Czech Republic.
¹⁷ Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁸ Neonatology and Paediatric Intensive Care Unit, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
¹⁹ Neonatology and Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, Acquaviva delle Fonti, Italy.
²⁰ Neonatology and Neonatal Intensive Care Unit, Policlinico Riuniti Foggia, Foggia, Italy.
²¹ Neonatologia e Terapia Intensiva Neonatale, University of Bari, Bari, Italy.
²² Perinatal Intensive Care Unit, Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary.
²³ Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
²⁴ Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western, Australia.

Abstract

Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.

Publication types

Review

MeSH terms

Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Antimicrobial Stewardship*
Beginning of Human Life
Humans
Infant, Newborn
Neonatal Sepsis* / drug therapy
Sepsis* / drug therapy

Substances

Anti-Bacterial Agents