Australian-led research finds frontline treatments are failing sick babies across Southeast Asia, prompting urgent calls to overhaul global guidelines.
Frontline treatments for sepsis in newborn babies are rapidly losing effectiveness, with Australian researchers making urgent calls for diagnostic and treatment guidelines to be overhauled.
A University of Sydney-led study published in The Lancet Regional Health – Western Pacific analysed almost 15,000 blood samples collected from sick newborns between 2019 and 2020 across 10 hospitals in Indonesia, the Philippines and three other Southeast Asian countries.
The results showed that most infections were caused by bacteria unlikely to respond to World Health Organization recommended treatments, which were developed using data from high-income countries rather than localised surveillance, which could be more accurate and therefore effective.
Senior author Associate Professor Phoebe Williams, a senior lecturer and NHMRC fellow in the Sydney School of Public Health, said the study revealed an “alarming burden of antimicrobial resistance (AMR) that renders many currently available therapies ineffective for newborns”.
“Guidelines must be updated to reflect local bacterial profiles and known resistance patterns. Otherwise, mortality rates are only going to keep climbing,” she said.
While the study did not include Australian cases, Professor Williams said the threat of AMR was a global problem.
“Antibiotic resistance spreads across borders,” she said.
“Thankfully in Australia we have robust data on infections, which will continue to play an important role in monitoring the appropriateness of our first-line therapies to treat serious infections as antibacterial resistance unfolds.
“We’re currently evaluating infection data across NSW hospitals to ensure our treatment strategies remain effective.”
Co-author Michelle Harrison, PhD candidate and project coordinator of the Neonatal Sepsis in Southeast Asia and the Pacific collaboration (NeoSEAP) in the Sydney School of Public Health said the findings were very relevant to Australia.
“Australia’s close ties to Southeast Asia and the Western Pacific mean we must stay vigilant and proactive in updating guidelines and developing new treatments in the face of these alarming findings,” she said.
As part of the study, samples which tested positive for fungal or bacterial infections were analysed to see whether they were caused by gram-positive or gram-negative bacteria.
Gram-negative bacteria such as E. coli, Klebsiella and Acinetobacter were responsible for nearly 80% of infections.
These pathogens, notorious for their ability to develop and spread antibiotic resistance, were once thought to affect older infants but are now frequently infecting babies within their first days of life.
This presented a major challenge for clinicians who must begin treatment before laboratory results are available. Even then, the results were often delayed or inconclusive due to the difficulty of collecting blood samples from newborns, the researchers said.
Ms Harrison said the lack of new antimicrobials compounded the crisis.
“It takes about 10 years for a new antibiotic to be trialled and approved for babies,” she said.
“With so few new drug candidates in the first place, we need a significant investment in antibiotic development.”
She emphasised that the findings also highlighted the importance of locally relevant data to guide routine medical decision-making.
“We need more region-specific surveillance to guide treatment decisions. Otherwise, we risk reversing decades of progress in reducing child mortality rates,” she said.
“Our results also revealed fungal infections caused nearly one in 10 serious infections in babies – a much higher rate than in high-income countries.
“We need to ensure doctors are prescribing treatments that have the best chance at saving a baby’s life.”
The Lancet Regional Health – Western Pacific, September 2025
