Simplified treatment of sick infants at risk of possible serious bacterial infection


To treat infections in newborns and young infants (age 0 to 59 days), WHO recommends transferring them to a hospital and administering a regimen combining two injectable antibiotics, namely, penicillin or ampicillin, plus gentamicin for seven to ten days. Implementation of this recommendation poses operational challenges because of the poor availability of organized and geographically accessible health facilities with integrated health services that can provide quality care to newborns. To find alternatives to the standard treatment protocol, several clinical trials involving simplified antibiotic regimens were conducted simultaneously in the DRC, Kenya, and Nigeria. The studies were wide in scope, including separately controlled and randomized trials. They compared therapeutic regimens in newborns and infants (0 to 59 days) who showed signs of infection and whose parents did not accept medical care at the referral level or were not able to transfer the infant. These trials found management of a possible serious bacterial infection (PSBI) in young infants in Africa is effective at the health center level when families do not accept referral to the hospital. On the basis of these studies, WHO implemented a new directive that does not replace the management of PSBI patients in the hospital setting but that can be recommended for the treatment of infants who show signs of serious infection in settings where resources are limited or families either do not accept or are unable to access referral care. This directive allows for use of simple, safe, and effective antibiotic regimens for ambulatory treatment of serious clinical infections and rapid breathing problems (pneumonia) in children between 0 and 59 days old. After adoption of the treatment protocol by DRC’s Ministry of Health (MOH), it was recommended that a demonstration site be set up before large-scale extension. The USAID-funded Integrated Health Project Plus (IHPplus), the Kinshasa School of Public Health (KSPH), WHO, and the Division Provinciale de Santé (DPS, or provincial health division) of Sud Kivu collaborated to test the application at 10 sites to manage neonatal infection when referral is not possible and to identify best practices, needs, and challenges before scale up.