Fuchs Aline, Bielicki Julia, Mathur Shrey, Sharland Mike, Van Den Anker Johannes N
a Paediatric Pharmacology and Pharmacometrics , University Children's Hospital Basel , Basel , Switzerland.
b Paediatric Infectious Disease Research Group, Institute for Infection and Immunity , St George's University of London , London , UK.
Paediatr Int Child Health. 2018 Nov;38(sup1):S3-S15. doi: 10.1080/20469047.2017.1408738.
Background Guidelines from 2005 for treating suspected sepsis in low- and middle-income countries (LMIC) recommended hospitalisation and prophylactic intramuscular (IM) or intravenous (IV) ampicillin and gentamicin. In 2015, recommendations when referral to hospital is not possible suggest the administration of IM gentamicin and oral amoxicillin. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for treating sepsis (taking into account susceptibility patterns, cost and risk of adverse events) in neonates and children is necessary. Methods Systematic literature review and international guidelines were used to identify published evidence regarding the treatment of (suspected) sepsis. Results Five adequately designed and powered studies comparing antibiotic treatments in a low-risk community in neonates and young infants in LMIC were identified. These addressed potential simplifications of the current WHO treatment of reference, for infants for whom admission to inpatient care was not possible. Research is lacking regarding the treatment of suspected sepsis in neonates and children with hospital-acquired sepsis, despite rising antimicrobial resistance rates worldwide. Conclusions Current WHO guidelines supporting the use of gentamicin and penicillin for hospital-based patients or gentamicin (IM) and amoxicillin (oral) when referral to a hospital is not possible are in accordance with currently available evidence and other international guidelines, and there is no strong evidence to change this. The benefit of a cephalosporin alone or in combination as a second-line therapy in regions with known high rates of non-susceptibility is not well established. Further research into hospital-acquired sepsis in neonates and children is required.
背景 2005 年针对低收入和中等收入国家（LMIC）疑似脓毒症治疗的指南建议住院治疗，并进行预防性肌内注射（IM）或静脉注射（IV）氨苄西林和庆大霉素。2015 年，对于无法转诊至医院的情况，建议使用肌内注射庆大霉素和口服阿莫西林。在抗菌药物耐药性不断增加的时代，有必要对新生儿和儿童脓毒症的适当经验性治疗进行更新回顾（考虑到药敏模式、成本和不良事件风险）。方法 采用系统文献综述和国际指南来识别关于（疑似）脓毒症治疗的已发表证据。结果 确定了五项设计充分且有足够样本量的研究，这些研究比较了 LMIC 低风险社区新生儿和幼儿的抗生素治疗。这些研究探讨了当前世卫组织参考治疗方法对于无法住院治疗的婴儿可能的简化方案。尽管全球抗菌药物耐药率不断上升，但对于医院获得性脓毒症的新生儿和儿童疑似脓毒症的治疗仍缺乏研究。结论 世卫组织目前支持在医院治疗的患者中使用庆大霉素和青霉素，或在无法转诊至医院时使用庆大霉素（肌内注射）和阿莫西林（口服）的指南与现有证据和其他国际指南一致，且没有有力证据改变这一情况。在已知非敏感性发生率高的地区，单独使用头孢菌素或联合使用头孢菌素作为二线治疗的益处尚未明确确立。需要对新生儿和儿童医院获得性脓毒症进行进一步研究。
