Less is more: Antibiotics at the beginning of life

Fear of missing neonatal sepsis has led to early in life antibiotic administration, even without culture-proven sepsis. Here, the authors discuss the potential impact on antimicrobial resistance, and chronic disease later in life, due to effect on the developing microbiome, suggesting a factual based approach in quantifying burden of treatment in relation to the burden of disease. Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.

Automated summary

Fear of missing neonatal sepsis drives early antibiotic administration in infants, despite lacking culture-proven sepsis. This practice can contribute to antimicrobial resistance and disruption of the developing microbiome, increasing the risk of chronic diseases later in life. To address this, a factual approach is advocated to balance the burden of treatment and disease, ensuring proper antimicrobial stewardship and sepsis management.