A randomized trial of chloramphenicol vs. trimethoprim-sulfamethoxazole for the treatment of malnourished children with community-acquired pneumonia

Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics

“…Table 2 shows the characteristics of clinical studies and the overall risk of bias in each study. 21,[26][27][28][29] Characteristics of pharmacokinetic studies are detailed in Table 3, Table 4 and Table 5. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] All included studies refer to children with SAM unless otherwise stated.…”

“…This trial was conducted from 1990-92 in a context of low resistance to cotrimoxazole and low HIV prevalence. 21 …”

“…Moreover, high rates of in vitro resistance to ampicillin and gentamicin have been reported in several African countries (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] According to discussions with staff members, institutions for the care of malnourished children vary in the degree to which they follow current recommendations. Many institutions are now giving more potent broad-spectrum antibiotics to hospitalized malnourished children guided largely by local in vitro sensitivity data.…”

“…2,3 Rationale for antibiotics in severely malnourished children Several epidemiological studies have documented a high prevalence of pneumonia, bacteraemia and urinary tract infections in children with malnutrition (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In this cohort a wide range of both Gram-positive and Gram-negative organisms are Objective To systemically review the evidence in support of World Health Organization guidelines recommending broad-spectrum antibiotics for children with severe acute malnutrition (SAM). Methods CENTRAL, MEDLINE, EMBASE, LILACS, POPLINE, CAB Abstracts and ongoing trials registers were searched.…”

“…[10][11][12][13][14][15] High rates of resistance to second-line antibiotics such as chloramphenicol, gentamicin and cephalosporins have also been reported in selected contexts, [12][13][14][15] while in general, sensitivity to ciprofloxacin remains high (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In vitro resistance, however, does not necessarily translate into lack of clinical efficacy.…”