October 28, 2014
1 min read

Diagnosis, treatment of bacterial infections subpar in low-, middle-income countries

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Diagnosis and treatment of neonatal infections in low- and middle-income countries requires improvement, according to study findings published in PLoS Medicine.

Anne C. Lee, MD, MPH, of Brigham and Women’s Hospital in Boston, and colleagues conducted a meta-analysis of 37 published studies, 46 WHO/Health Action International national surveys and eight service provision assessments to assess diagnosis of possible bacterial infections among infants and antibiotic availability in low- and middle-income countries.

Anne C. Lee, MD, MPH

Anne C. Lee

Analysis indicated clinical sign-based algorithms had a high sensitivity (87%; 95% CI, 82%-91%) and lower specificity (62%; 95% CI, 48%-75%) for predicting bacterial infection among infants.

Front-line health care workers diagnosed possible bacterial infections among infants at an average sensitivity of 82% (95% CI, 76%-88%) and specificity of 69% (95% CI, 54%-83%), compared with physicians.

Availability of first-line injectable antibiotics ampicillin, gentamicin and penicillin was low and variable among first-level health care facilities in Africa and south Asia. Oral amoxicillin and cotrimoxazole had high availability at low cost in many regions, according to researchers.

Twenty-five percent of pediatric antibiotic purchases in low- and middle-income countries were completed without a prescription (95% CI, 18%-34%). These rates were lower among infants aged younger than 1 year, though study data for neonates was limited, according to researchers.

“Improving diagnosis and access to treatment for neonatal infections are critical steps to reducing neonatal morbidity and mortality,” the researchers wrote. “The development of novel, low-cost and user-friendly diagnostics to improve the accuracy of detecting neonatal infections may play a critical role in improving access to treatment and reducing inappropriate antibiotic use in low-resource settings.”

To improve availability and pricing of antimicrobials in low- and middle-income countries, governments, policy makers and the pharmaceutical industry must work together, according to researchers.

Disclosure: One of the researchers was an investigator on two studies included in the meta-analysis. The other researchers report no relevant financial disclosures.