The drugs are not working as well as they used to.

The drugs are not working as well as they used to.

This sobering conclusion comes from a new study published last week in The Lancet Regional Health – Southeast Asia: the most commonly prescribed antibiotics in Southeast Asia are currently only 50% effective in treating sepsis and meningitis in newborns.

And this is a serious failure. Sepsis kills 1 in 5 patients. Meningitis is responsible for a quarter of a million deaths annually, half of which occur in children under the age of 5. Overall, childhood infections account for more than 550,000 deaths every year.

Why aren't the drugs doing their job? It's because the overuse of these drugs has led to the development of antibiotic-resistant infections – bacteria and other diseases that no longer respond to treatment.

Dr. Phoebe Williams, a physician and lecturer at the University of Sydney (Australia) and the lead author of the new study, says that these antibiotic-resistant infections are responsible for "about 5 million deaths each year," both in children and adults.

Approximately 1 million of these deaths occur annually in Southeast Asia.

Especially vulnerable are infants. While the immune system of an adult is often strong enough to fight these infections, children who haven't had the opportunity to strengthen their immunity suffer the most severe consequences.

Recommended WHO treatment methods are outdated According to the World Health Organization, over the past 30 years, improvements in maternal and infant healthcare have helped reduce child mortality by half; mortality has decreased from 5 million per year in 1990 to 2.4 million in 2020. But infections still pose one of the biggest threats to newborns. The rise in infections resistant to antimicrobial drugs is a serious obstacle to achieving the UN goal of ending all preventable cases of neonatal mortality by 2030.

Williams' study shows that in Southeast Asia, these infections are becoming increasingly resistant to antimicrobial drugs. "For example, in one ward we work with in the Philippines, the mortality rate from neonatal sepsis has increased from 20% a decade ago to 75% in the last two years," says Williams.

It's not just the Philippines. The new study shows that antimicrobial resistance is becoming a more serious problem "in low- and middle-income countries in Southeast Asia and the Pacific region," according to Ramanan Laxminarayan, a senior research scholar at Princeton University who was not involved in the new study.

Among the study's findings is the discovery that many drugs recommended by the World Health Organization in 2013 for treating childhood infections no longer work.

According to the study, ceftriaxone, one of the recommended drugs, is currently effective only in treating 1 in 3 cases of neonatal meningitis. Another recommended drug, gentamicin, only cures neonatal sepsis and meningitis in half of the cases.

Laxminarayan says that WHO recommendations are being reconsidered to recommend more effective treatment methods. Meanwhile, many doctors in affected countries have to choose the most suitable course of action themselves.

The responsibility for this lies with overcrowded hospitals and the overuse of drugs. In many places, a lack of healthcare resources exacerbates the problem of antimicrobial resistance, which is growing worldwide. "When one nurse is taking care of 15–20 infants, they may not have time to wash their hands after each child," says Williams.

In such conditions, infections resistant to antimicrobial drugs can spread "very quickly." And when drugs don't work, there's little that can be done.

Williams says the solution is to carefully study both old and new drugs to determine the most effective treatment methods for children.

She says that using old drugs is "likely one of our strongest options because these drugs are not patented." Now that the original patents have expired, cheaper generics are available. And since these drugs have not been widely used for many years, some infections may no longer be resistant to them.

New drugs have been developed to fight infections resistant to antimicrobial drugs, but they are rarely approved for use in children. Williams says that "since 2000, 40 antibiotics have been licensed for adults and 4 for infants, despite infants bearing a much greater burden of AMR." Williams says the reason many of these drugs are not approved for children is that they require different dosing regimens than adults. Determining the right dose for children is often not a priority when companies first seek approval.

The excessive prescribing of antibiotics to adults and their widespread use in agriculture contribute to the rise of infections resistant to antimicrobial drugs, notes Williams.

A class of drugs called carbapenems works well… for now One class of drugs that, as Williams' research shows, is still effective and approved for children is carbapenems, a set of powerful antibiotics containing many different drugs that are administered intravenously and are often used as a last resort for treating severe infections. Carbapenems are usually not prescribed unless absolutely necessary, as they are expensive, intravenous administration is invasive, and they are not widely available in every country.