Background: Neonatal sepsis remains a significant concern in healthcare settings globally, particularly in regions with limited resources such as Zambia. Study objective: The main objective of the study was to assess the effectiveness of first-line antibiotics in treating early onset neonatal sepsis. Study methods:

This retrospective cross-sectional study conducted at Livingstone Teaching Hospital aimed to assess the effectiveness of first-line antibiotics in the treatment of early onset neonatal sepsis. Medical records of neonates admitted to the Neonatal Intensive Care Unit from January to June 2023 were reviewed.

Results: The study investigated the effectiveness of first-line antibiotics in treating early onset neonatal sepsis among 92 infants. Descriptive statistics revealed that the mean age upon admission was 1.64 days, gestational age at birth was 36.83 weeks, temperature on admission was 37.58°C, and APGAR score at birth was 7.84. Most infants (83.7%) showed evidence of neonatal infection upon admission, with pyrexia being the most common symptom (51.1%). Cultures were requested for a minority of cases (10.9%), yielding positive results in all cases. Initial antibiotic therapy was predominantly initiated on day one (83.7%), with Xpen and gentamicin being the preferred first-line antibiotics (97.8%).

Clinical response to treatment was observed in the majority of cases (72.8%), while 27.2% were classified as non-respondents, with a notable proportion requiring switching to second-line antibiotics (27.2%). Temperature on admission was identified as a significant predictor of non-response to first-line antibiotics, with lower temperatures associated with decreased odds of non-response. No significant associations were found between various categorical predictor variables and the clinical outcome of respondents and non-respondents to first-line antibiotics.

Conclusion: Findings revealed a notable prevalence of neonatal infections upon admission, with pyrexia being the most common symptom.Temperature on admission emerged as the significant vital sign in predicting the effectiveness of first line antibiotics in the treatment of neonatal sepsis, emphasizing its importance in treatment outcomes.

Despite challenges such as antibiotic resistance and the need for second-line treatments, The study found that the overall effectiveness of first-line antibiotics in the management of neonatal sepsis at the Livingstone Teaching Hospital NICU was 72%.This suggest that the use of first-line antibiotics was generally effective in treating Early onset neonatal sepsis in this setting. However,the study also identified areas for improvement such as the need for more comprehensive antibiotic stewardship programs, improved laboratory capacity for pathogen identification, and closer monitoring of antibiotic resistance patterns.