Antibiotic use and resistance in children with severe acute malnutrition and human immunodeficiency virus infection

Effect of amoxicillin on the gut microbiome of children with severe acute malnutrition in Madarounfa, Niger: a retrospective metagenomic analysis of a placebo-controlled trial

“…The cost–benefit calculation for providing routine antibiotic treatment to children with uncomplicated SAM requires consideration of both the potential benefits of possible immediate individual weight gain, nutritional recovery, decreased hospitalisation, and lower mortality with the potential future risk of infections with antibiotic-resistant organisms and their spread within the community. 6 , 24 The microbiome and antibiotic resistome results presented here are consistent with previous findings that amoxicillin can promote positive clinical outcomes in severely malnourished children. 4 , 25 Additionally, amoxicillin could help the gut microbiota adapt to a more mature diet by reducing the abundance of taxa specialised for milk utilisation such as Bifidobacterium spp.…”

“… 27 The major argument against the use of routine antibiotics in vulnerable populations is the loss of microbial diversity and selection for resistant pathogens, which could be particularly severe in patients who are immunocompromised and in settings where health-care infrastructure is inadequate. 1 , 6 Immediately after amoxicillin treatment, we observed increases in overall ARGs and potentially antibiotic resistant Klebsiella spp and Escherichia spp. Fortunately, the negative consequences of microbiome and resistome perturbation appeared to be short-lived, having disappeared by 3 weeks from the conclusion of treatment, and we further observed several unexpected long-term benefits to amoxicillin treatment, including improved long-term microbiome richness, diversity, and maturation.…”

“… 10 Broad spectrum antibiotics could further deplete commensal microbial defences and inhibit the immune system. 6 The increase of potential pathogens in children with an age-regressed microbiome and immune health could have negative consequences leading to invasive antibiotic-resistant bacterial infections. 6 Nutritional interventions such as ready-to-use therapeutic foods have been shown to temporarily improve the maturation of the gut microbiome and anthropometric scores; however, this improvement is not always sustained.…”

“… 6 The increase of potential pathogens in children with an age-regressed microbiome and immune health could have negative consequences leading to invasive antibiotic-resistant bacterial infections. 6 Nutritional interventions such as ready-to-use therapeutic foods have been shown to temporarily improve the maturation of the gut microbiome and anthropometric scores; however, this improvement is not always sustained. 10 , 11 Over the past 5 years, rationally designed microbiota-directed therapeutic foods have shown promise in microbiome restoration and improvement in anthropometric scores of children with moderate and severe acute malnutrition.…”

“… 5 However, uncertainty still exists on the potential consequences (eg, development of antibiotic resistance and microbiome disruption) of antibiotic treatment in children with severe acute malnutrition. 6 One hypothesis for the benefit of antibiotics has been a reduction in subclinical or clinical diarrhoeal or respiratory infections. 4 , 5 , 7 Alternately, it is possible that the beneficial effects of antibiotics in this population act through alteration of the gut microbiome.…”