Raising awareness and creating a sense of urgency.
New strategies to treat truly infected babies as early as possible and non-infected babies as little as possible.
In the western countries, up to 10% of babies are treated with antibiotics within the first week of life. But only 1 baby out of 1000 to 5000 has a proven bacterial infection. Therefore, medical doctors in Europe, in the USA or Australia treat a lot of babies unnecessarily. Why is this? A bacterial infection may kill a baby. Starting a therapy with antibiotics as early as possible may be lifesaving for babies truly infected. Therefore, many babies with a small risk to have a bacterial infection are currently treated with antibiotics. Unfortunately, there is no easy way to distinguish truly infected babies from babies with symptoms due to other reasons (i.e. respiratory distress due to a prolonged adaptation process after birth). Fear to miss a truly infected baby is the driver of this massive overuse of antibiotics.
Within the last decade, clinical researchers were increasingly able to show that unnecessary antibiotics may harm the baby. Exposure to antibiotics early in life may change the individual microbiota, the good bacteria within our body. A disruption of the early development of the microbiota may have future consequences for the individual health of the baby. Chronic illnesses as inflammatory bowel diseases, eczema, diabetes or asthma may be triggered through an abnormal development of the microbiota. And the beginning of life is the most important period in life for development of the microbiota. In addition, unnecessary antibiotics promote the resistance of bacteria and there is a true risk that we may not be able to treat truly infected babies in the future due to resistant bacteria.
"There is a huge overtreatment of babies with antibiotics within the first week of life"
Raising awareness can make a difference. If a mother knows about the problem of unnecessary antibiotic therapy, she may ask her doctor if the treatment is truly necessary or if the treatment is more a standard management to her baby with only minimal risks. She may discuss alternative options as close observation of her baby at the hospital and starting antibiotics only if her baby develops clinical symptoms. Important note: In some babies antibiotics are truly needed and may be lifesaving.
Medical doctors have completed a long training to be doctors. Prescription of antibiotics is one of the most frequent actions done by doctors. As we all know, it is not easy to change. To change a longstanding management, doctors need to be convinced that this change is truly necessary. Therefore, we need to create a sense of urgency. Doctors need to know the problem of unnecessary antibiotics and they need to know that parents care about that problem. Medical publications and educational programs for doctors are one way to support this change process. The questions and requests of the public are other ways to create a sense of urgency. In the decade of family-centred care, parents and family members with their vision and prospect are key for the management plan of their children. Therefore, we need your support as parents, future parents, families, and relatives.
"Creating a sense of urgency is mandatory for every change process"
First of all, we need to define the precise dimension of the problem. This is important because many doctors and hospitals think they are doing better than they really are. To define the problem we launched the AENEAS study (Antibiotic Exposure for suspected Neonatal EArly-onset Sepsis). Data from thousands of neonates treated with antibiotics within the first week of life are collected in more than 50 hospitals and 13 countries (further information). The plan is to discuss the results inter-professionally with health care workers caring for babies (doctors, mid-wives, nursing staff, lactation specialists), with parent communities and organisations, as well as with supporters of LA4B. Aims are to increase awareness and to develop educational programs and future studies to improve the management at the start of life.
As a second strategy, we need to increase the evidence of the benefit of "less antibiotics for babies". Evidence is emerging from different study groups and the number of publications on this topic is increasing. Nevertheless, there is a need to continuously evaluate the new scientific data to determine whether clinical practice needs to be changed. In addition, a large study is needed to prove the concept "less antibiotics for babies". Currently, clinical researchers of our group (nest-net.org) are collaborating with international experts in the field aiming to design and launch such a study. We plan to discuss the study proposal with parent communities and organisations, as well as with supporters of LA4B to include different views and opinions. To prove that changes of the microbiota due to antibiotic exposure early in life are responsible for later health conditions, a follow up of several years or eventually decades is mandatory.