A randomised trial in the Netherlands looked at the effect of broad-spectrum antibiotic treatment on infants in their first week of life. The 147 babies were treated for suspected early-onset neonatal sepsis (sEONS), and randomised 1:1:1 to receive three different intravenous antibiotic combinations that are routinely prescribed for this condition. Each was given for an average of 48 hours. A control group of 80 babies not receiving antibiotic treatment were studied at the same time.

Rectal swabs and stool samples were taken from the participants both before and after the antibiotic treatment, as well as at months 1, 4, and 12 following treatment.

The researchers found a significant difference in gut microbiota immediately following treatment, which slowly normalised over the following 12 months. In particular, decreased Bifidobacterium spp. and increased Klebsiella and Enterococcus spp. were found. A small difference remained between the microbiota of those who had received antibiotics and the control group at 12 months. 

Of the three antibiotic combinations, amoxicillin + cefotaxime was seen to cause the largest change, while pencillin + gentacimin had less of an effect on the infants’ microbiomes.

Conclusion: The researchers concluded that although current guidelines aim to reduce the length of antibiotic treatment, significant impact can be seen within only 48 hours. Approximately 4-10% of neonates are prescribed broad-spectrum antibiotics, while only 1 in 1000 are understood to develop sEONS. They suggest that improving diagnostic accuracy may be a less-impactful approach than administering antibiotics to infants that may not require them.

Reyman, M. et al. (2022) Effects of early-life antibiotics on the developing infant gut microbiome and resistome: a randomized trial. Nature Communications. 13,893. doi:10.1038/s41467-022-28525-z

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