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Appropriate and timely antibiotic administration for neonatal sepsis in Mesoamérica
  1. Herbert C Duber1,2,
  2. Emily A Hartford3,
  3. Alexandra M Schaefer1,
  4. Casey K Johanns1,
  5. Danny V Colombara1,
  6. Emma Iriarte4,
  7. Erin B Palmisano1,
  8. Diego Rios-Zertuche4,
  9. Paola Zuniga-Brenes4,
  10. Bernardo Hernández-Prado1,
  11. Ali H Mokdad1
  1. 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  2. 2 Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
  3. 3 Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, Washington, USA
  4. 4 Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama
  1. Correspondence to Dr Herbert C Duber; hduber{at}


Neonatal sepsis is a leading cause of mortality among children under-5 in Latin America. The Salud Mesoamérica Initiative (SMI), a multicountry results-based aid programme, was designed to improve maternal, newborn and child health in impoverished communities in Mesoamérica. This study examines the delivery of timely and appropriate antibiotics for neonatal sepsis among facilities participating in the SMI project. A multifaceted health facility survey was implemented at SMI inception and approximately 18 months later as a follow-up. A random sample of medical records from neonates diagnosed with sepsis was reviewed, and data regarding antibiotic administration were extracted. In this paper, we present the percentage of patients who received timely (within 2 hours) and appropriate antibiotics. Multilevel logistic regression was used to assess for potential facility-level determinants of timely and appropriate antibiotic treatment. Among 821 neonates diagnosed with sepsis in 63 facilities, 61.8% received an appropriate antibiotic regimen, most commonly ampicillin plus an aminoglycoside. Within 2 hours of presentation, 32.3% received any antibiotic and only 26.6% received an appropriate regimen within that time. Antibiotic availability improved over the course of the SMI project, increasing from 27.5% at baseline to 64.0% at follow-up, and it was highly correlated with timely and appropriate antibiotic administration (adjusted OR=5.36, 95% CI 2.85 to 10.08). However, we also found a decline in the percentage of neonates documented to have received appropriate antibiotics (74.4% vs 51.1%). Our study demonstrated early success of the SMI project through improvements in the availability of appropriate antibiotic regimens for neonatal sepsis. At the same time, overall rates of timely and appropriate antibiotic administration remain low, and the next phase of the initiative will need to address other barriers to the provision of life-saving antibiotic treatment for neonatal sepsis.

  • health systems
  • child health
  • health systems evaluation
  • paediatrics

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Alberto L Garcia-Basteiro

  • Contributors HCD designed the study. HCD and EAH wrote the first draft of the manuscript. AMS, CKJ and DVC contributed to data preparation, analysis and manuscript revisions. EBP, BHP and AHM contributed to survey design, sampling, data quality supervision and interpretation of results. DRZ and PZB contributed to project oversight, study design, survey operation and interpretation of results. BHP, EI and AHM oversaw the project and guided analysis. All authors read and approved the final manuscript.

  • Funding This study was funded by Bill and Melinda Gates Foundation (10.13039/100000865), Agencia Española de Cooperación Internacional para el Desarrollo (10.13039/501100004892), and the Carlos Slim Foundation, through the Inter-American Development Bank (10.13039/100004429).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Washington Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are owned by the Inter-American Development Bank. SMI baseline survey data, which comprises the minimal dataset, are publicly available on the SMI website: . SMI follow-up survey data are currently available upon written request with the Inter-American Development Bank whose contact information is listed below. Jennifer A. Nelson, MPH Learning, Innovation, and Technology Officer () Salud Mesoamérica Initiative Calle 50, Edificio Tower Financial Center (Towerbank) – Piso 23 Panamá, Panamá.

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