We often hear concerns from parents of babies taken into neonatal units after birth about the possible adverse effects of antibiotics that seem to be given routinely. They are also upset about the distress caused to the baby by injections or the insertion of needles or tubes.
As all of us know nowadays, our intestines are lined with bacteria that aid digestion, and antibiotics tend to kill off these good, helpful flora as well as killing off the baddies. And when the good guys are missing, there is more room for the bad guys to take over.
A new study from France looks at the effects of two different types of antibiotic treatment on the bacteria found in 20 babies’ faeces, and compared them with a control group of 10 infants who were admitted to the unit, but not thought to need antibiotic treatment.
Babies with suspected infection from the mother are routinely treated with antibiotics. The initial treatment is usually a combination of two drugs-amoxicillin plus netilmicin. If the mother had contracted a urinary tract infection in the month before the birth, a third drug is added-cefotaxime- because the bacteria likely to cause this are often resistant to amoxicillin. The triple combination is also used in babies with severe symptoms. Sometimes, the mother has already been started on these drugs before the birth of the baby. Babies were treated with antibiotics for 48-72 hours.
Doctors collected stool samples from the babies before antibiotics were given, and then at three, seven and 10 days. In the (untreated) control group, colonisation with the normal, different types of intestinal flora began within three days. In this group, those babies whose mothers had been treated with amoxicillin during the birth had amoxicillinresistant Escherichia coli. By the seventh day, all the babies were colonised with staphylococci, mostly Staphylococcus epidermidis, most of which were resistant to cefotaxime.
Babies in the two-drug group had colonisation similar to normal in that flora also appeared during the first three days and they grew diverse flora-but the pattern was rather different. Those whose mothers had been given antenatal antibiotics had low levels of organisms.
It was the three-drug group that had a very different pattern, which persisted for 10 days, although treatment was only for three days. Colonisation of the intestine began later and there was not a healthy range of bacteria. There was mostly one type of staphylococcus.
Three babies had high levels of Candida. The researchers say this is disturbing because cases of Candida septicaemia have been increasing. The authors think the high level and rapid growth of staphylococci is caused by the absence of other bacteria, which have been killed off by the cefotaxime.
AIMS comments
The numbers in the study are unfortunately small, but still we welcome it. We receive an increasing number of complaints from parents that their babies are admitted to neonatal units without adequate reason (this particularly seems to be an automatic, controlling, almost punitive reaction when babies are admitted after a home birth), and also reports of hostile reactions from paediatricians if the parents question any of the investigations or treatment given. Yet more reports-including this one-show that mere admission to the neonatal unit can result in the baby acquiring potentially harmful organisms (e.g. antibiotic- resistant staphylococci colonising the skin) and receiving unnecessary treatment, invasive tests or treatments that carry adverse effects, as well as interfering with breastfeeding and bonding. We have the right to ask questions-and AIMS will continue to support parents who do so.
Reference
- Bonnemaison E et al. Comparison of fecal flora following administration of two antibiotic protocols for suspected maternofetal infection. Biol Neonate, 2003; 84: 304-10