Simplified Treatment of Possible Severe Bacterial Infection in Young Infants When Referral is not Feasible. What Happened There? What are the Implications Here?

Severe bacterial infections remain one of the three leading causes of newborn death world-wide. Most such deaths could be prevented with timely and appropriate antibiotic treatment. However in low-income countries, there are many such cases for which, practically speaking, it is not currently feasible to offer gold-standard, in-patient treatment with 7 days of parenteral antibiotics. Recent trial results, however, provide evidence for efficacy using simpler out-patient antibiotic regimens, equivalent to treatment with 7 days of procaine penicillin and gentamicin, given on an outpatient basis. Based on these findings, the World Health Organization has recently released guidelines endorsing such an approach for cases for which referral for inpatient treatment is not feasible. This brief report looks beyond the measured effect sizes in the published trials to other details on how they were implemented and what outcomes were observed for different groups of study participants. The report considers, further, the circumstances in country settings where such a strategy may be appropriate and offers issues for consideration by policy makers.