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Let's make something about the Messy Management of Infections!


Stefan Johansson

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This is a conceptual - philosophical issue that may also be discussed in the Lounge or in a Blog post. But I decided to post it here!

This interesting thread underscored what I have thought about for a pretty long time, that the management of infections has a pretty weak evidence-base. And that we should try do something about it! We do not know terribly much which drug combinations to use and dosing schedules.

You may think "so what... are there not a lot of clinical management scenarios that cannot be backed up by the level-A evidence?"

I'd say that's a completely valid point, but infections are really an every-day clinical problem. It would not be hard to recruit many 100s of infants in well-designed clinical trials, where various treatment protocols could be evaluated.

I think one would glance at Pediatric Oncology (completely different field, I know). In Scandinavia (and I guess in other regions too), they have been very successful in designing well-functioning treatment protocols, by tedious but efficient collaborative work.

One may argue that Pediatric Oncology works with more expensive drugs, and I agree that antibiotic-treatment may not attract a lot of industrial funding. One the other hand, funding from other (independent) sources may not prove to be that difficult considering that antibiotics are so cheap.

Another argument not to start such trials is that the etiology of infections is a moving target (species differ, various strains develop etc-etc). I'd say - a moving target - makes the challenge even more adventureous!

Let's clear up the mess of antibiotics, immunoglobulins, granulocyte stimulation, pro-biotics etc-etc. We need to know more, to do better.

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Dear Stefan,

A wonderful idea as there are so many, many questions with no evidence based answers e.g, best diagnostic tests to diagnose neonatal infections, best antibiotic therapy, duration of therapy (culture proven, culture negative but lab and clinical sepsis, ideal monitoring and duration of follow-up. The problem is that 100 patients wont do. As you know just to see the difference in mortality with adjuvant IVIG therapy (INIS study) we needed 5000 infants to get a study with adequate power.

Regards

Khalid

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