Experts say that clinicians should consider using antibiotics in a way that causes the least harm to the newborn's microbiome - the community of microbes that live in our bodies. Under current guidelines, antibiotics directed at a wide range of bacteria – known as broad-spectrum – are currently prescribed to four to 10 per cent of all newborns for suspected infections. However, experts say that in most cases the antibiotics are prescribed unnecessarily as only a small proportion of those who receive the drugs are eventually diagnosed with an infection.
This overprescription is to ensure early treatment for those who are ultimately found to have an infection as any delay may quickly become life-threatening. Researchers from the Universities of Edinburgh and Birmingham, and the Spaarne Hospital and University Medical Centre Utrecht, The Netherlands, conducted a clinical trial involving 227 babies to analyse how antibiotics affect a newborn’s microbiome.
Some 147 infants with suspected sepsis received one of three standard antibiotic treatments. Their outcomes were compared with those of 80 babies with no suspected infections and those who were not prescribed an antibiotic. All babies had a rectal or faecal sample taken before and after treatment, and at one, four and 12 months of age. The samples were analysed for the microbes that made up their newly forming microbiome and for bacterial genes related to antimicrobial resistance.
For newborns that had been prescribed antibiotics, there was found to be a significant decrease in the levels of different Bifidobacterium species compared with babies who had no antibiotic treatment. These microbes aid in the digestion of human breast milk and promotes gut health, while also supporting the immune defence against infection.
The team also found an increase in potentially disease-causing bacteria and in the number and abundance of genes related to antimicrobial resistance in the group that received antibiotics. A change in 251 of 695 different bacteria investigated was observed after treatment, changing the balance between good and bad bacteria in favour of more potentially harmful microbes. Though gradually recovering over time, the changes to the microbiome and to antimicrobial resistance genes persisted for at least 12 months and did not improve with breastfeeding, which is known to help a baby’s immune system.
Of the three antibiotic treatment regimens tested, the combination of penicillin and gentamicin was found to have the least detrimental effect on a baby’s gut microbiome and the number of antimicrobial resistance genes that emerge. The researchers conclude this particular combination of antibiotics should be preferably prescribed when treating suspected infections in newborns.
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