KARACHI: Implementing a combination of regulation, healthcare workers’ training and rational antibiotic use can reduce newborn deaths by 27 percent, cut multidrug resistant infections by 29 percent and lower unnecessary antibiotic use by nearly one third in low and middle income countries, according to a major study led by Prof Zulfiqar A Bhutta, which outlines practical solutions to tackle antimicrobial resistance in neonatal care.
Published in The Lancet Global Health, the study was co-authored by Rachel Lee Him, Davneet Sihota, Leila Harrison, Angela Dramowski, Susan E Coffin and Davidson H Hamer, along with Prof Zulfiqar A Bhutta.
The study found that integrated interventions also reduce prolonged antibiotic use by 64 percent and decrease the risk of culture confirmed sepsis by 32 percent, highlighting the impact of coordinated strategies in improving newborn outcomes.
Prof Bhutta said the findings provide clear evidence that addressing antimicrobial resistance in newborns requires a comprehensive approach combining system level reforms, provider education and responsible prescribing practices.
The research analysed data from multiple studies conducted in healthcare facilities across low and middle income countries and evaluated the effectiveness of different strategies aimed at reducing antimicrobial resistance in newborn care.
Antimicrobial resistance, which occurs when microbes become resistant to commonly used medicines, is a growing global threat and is particularly severe in countries like Pakistan where antibiotics are widely used and often prescribed without proper diagnostic support.
Globally, around 214,000 newborns die each year from infections caused by drug resistant organisms, with the highest burden in resource limited settings.
The study found that isolated interventions, such as restricting antibiotic use alone, have limited impact. In contrast, combining regulation, education and optimisation of antibiotic use produced measurable reductions in mortality, infection rates and antibiotic exposure.
Optimisation strategies focusing on rational antibiotic use reduced the risk of confirmed sepsis and lowered the number of newborns receiving antibiotics, while integrated approaches further improved survival outcomes.
Researchers noted that improving prescribing practices without strengthening infection prevention and health system capacity is unlikely to significantly reduce mortality. The findings are highly relevant for Pakistan, where neonatal infections remain a leading cause of death and antibiotic misuse is common due to limited diagnostic facilities.
One of the major challenges identified in the study was weak microbiology laboratory capacity in low resource settings. Delays in culture results or lack of testing facilities often force doctors to rely on empirical treatment, increasing unnecessary antibiotic use.
Other barriers include overcrowded hospitals, shortage of trained staff, poor adherence to infection prevention measures and lack of standardised antibiotic guidelines. The study also found that doctors often continue antibiotics even when laboratory results are negative due to fear of complications or lack of confidence in stopping treatment.
Experts say strengthening infection prevention practices such as hand hygiene, sterilisation and patient isolation can significantly reduce hospital acquired infections among newborns.
Prof Bhutta emphasised the need for investment in laboratory infrastructure, training of healthcare workers and improved monitoring of antibiotic use to effectively tackle antimicrobial resistance.
The study also highlighted systemic issues including limited funding, weak governance and inequitable access to healthcare as key drivers of antimicrobial resistance in low and middle income countries. Health experts warn that without urgent action, antimicrobial resistance could lead to millions of deaths globally in the coming decades, with newborns among the most vulnerable.
The findings suggest that relatively low cost, integrated interventions can significantly improve newborn survival and reduce the spread of drug resistant infections. For countries like Pakistan, the study provides a clear direction to strengthen infection control, regulate antibiotic use and build health system capacity to protect newborns from life threatening infections.
