Continuation of indoor prescribed antibiotics in the outpatient treatment of neonatal sepsis

Abstract

Neonatal sepsis is a common problem whose antibiotic treatment is usually recommended whilst admitted in hospital for at least 10-14 days. Families in Bangladesh however are reluctant to stay in hospital to complete the treatment for such a long time due to reasons such as financial difficulties and either or both are working parents. This leads to incomplete treatment of neonatal sepsis. We hypothesised that after initial improvement in neonatal sepsis with injectable antibiotics whilst admitted, the same treatment could be safely continued in the outpatient setting to complete the full course. This intervention study was carried out in 66 newborns (0-28 days) recruited at the time of admission with suspected sepsis in the Department of Paediatrics, Centre for Woman and Child Health (CWCH), Dhaka. After investigations, treatment was initiated with injectable antibiotics according to clinical diagnosis and severity. Families who agreed to stay and complete the treatment as inpatient were given the complete course of antibiotics in hospital as IPD group and those who wanted to shorten their stay in hospital, were discharged with injectable antibiotics and follow-up in the outpatient department as OPD group. Data were analysed on 59 neonates, 37 in the OPD and 22 in the IPD group, admitted to hospital between April 2014 and December 2015. There were no readmissions or complications in either group, but one newborn died in the IPD group. Cure rate was 100% in both OPD and IPD groups. Average duration of hospital stay was 3.95±1.76 days and 6.14±2.99 days in the OPD and IPD groups respectively. Treatment cost per patient was 5,823±3,752 Bangladesh Taka (BDT) and 7,082±6,520 BDT in the OPD and IPD groups respectively. Findings of this study suggest that early discharge with injectable antibiotics as an outpatient is a safe and cost effective option for neonatal sepsis.