Does reducing antibiotic use help lower neonatal sepsis mortality rates?
Neonatal sepsis is a serious infection in newborns that can lead to death. Antibiotics are crucial for treating sepsis, but overuse can fuel antimicrobial resistance (AMR), making infections harder to treat. Reducing unnecessary antibiotic use through careful stewardship may help lower sepsis mortality by preserving the effectiveness of antibiotics and preventing complications. Evidence from low- and middle-income countries (LMICs) suggests that strategies to optimize antibiotic use can reduce both antibiotic consumption and death rates in newborns.
What the research says
A 2025 systematic review and meta-analysis examined antimicrobial resistance (AMR) mitigation strategies for newborns in LMICs 2. The review categorized strategies into regulation (structural changes), education (healthcare worker training), and optimization (responsible antibiotic use). Pooled data showed that these strategies reduced antibiotic use and were associated with lower neonatal mortality 2. This suggests that reducing unnecessary antibiotic use, rather than broadly cutting all antibiotics, can improve outcomes.
Other research highlights the importance of accurate diagnosis to avoid unnecessary antibiotics. A meta-analysis found that the biomarker IL-27 is more accurate than C-reactive protein (CRP) for diagnosing neonatal sepsis, with higher sensitivity (82% vs. 73%) 1. Better diagnostic tools can help clinicians target antibiotics to truly infected infants, reducing overuse.
Preventive measures also reduce the need for antibiotics. A Cochrane review found that applying chlorhexidine to the umbilical cord in LMICs reduces neonatal mortality and infection 5. Similarly, a vaccine against Klebsiella pneumoniae, a common cause of neonatal sepsis, could reduce the need for antibiotics 4. These approaches lower infection rates, thereby decreasing antibiotic use and potentially mortality.
However, not all antibiotic use is harmful. A large trial found that giving a single dose of azithromycin to women during labor reduced maternal sepsis or death, but did not reduce stillbirth or neonatal sepsis or death 6. This shows that targeted antibiotic use in specific situations can be beneficial, while indiscriminate use may not help newborns.
What to ask your doctor
- What antimicrobial stewardship programs are in place in our hospital's neonatal unit?
- How does our team decide when to start and stop antibiotics for suspected neonatal sepsis?
- Are there newer diagnostic tests, like IL-27, available to help confirm sepsis and avoid unnecessary antibiotics?
- What preventive measures, such as chlorhexidine cord care, are recommended to reduce infection risk in newborns?
- Could maternal vaccination against common sepsis-causing bacteria be an option to protect my baby?
This question is drawn from common patient questions about Infectious Disease and answered using cited medical research. We do not provide individualized advice.