Antibiotics as Part of the Management of Severe Acute Malnutrition

Abstract

BACKGROUND Severe acute malnutrition contributes to 1 million deaths among children annually. Adding routine antibiotic agents to nutritional therapy may increase recovery rates and decrease mortality among children with severe acute malnutrition treated in the community. METHODS In this randomized, double-blind, placebo-controlled trial, we randomly assigned Malawian children, 6 to 59 months of age, with severe acute malnutrition to receive amoxicillin, cefdinir, or placebo for 7 days in addition to ready-to-use therapeutic food for the outpatient treatment of uncomplicated severe acute malnutrition. The primary outcomes were the rate of nutritional recovery and the mortality rate. RESULTS A total of 2767 children with severe acute malnutrition were enrolled. In the amoxicillin, cefdinir, and placebo groups, 88.7%, 90.9%, and 85.1% of the children recovered, respectively (relative risk of treatment failure with placebo vs. amoxicillin, 1.32; 95% confidence interval [CI], 1.04 to 1.68; relative risk with placebo vs. cefdinir, 1.64; 95% CI, 1.27 to 2.11). The mortality rates for the three groups were 4.8%, 4.1%, and 7.4%, respectively (relative risk of death with placebo vs. amoxicillin, 1.55; 95% CI, 1.07 to 2.24; relative risk with placebo vs. cefdinir, 1.80; 95% CI, 1.22 to 2.64). Among children who recovered, the rate of weight gain was increased among those who received antibiotics. No interaction between type of severe acute malnutrition and intervention group was observed for either the rate of nutritional recovery or the mortality rate. CONCLUSIONS The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates. (Funded by the Hickey Family Foundation and others; ClinicalTrials.gov number, NCT01000298.)

Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children

“…15 In that study, amoxicillin significantly reduced the risk of treatment failure (by 24%) and death (by 36%), as compared with placebo. The authors concluded that antibiotics should continue to be used routinely in areas where kwashiorkor and HIV infection are prevalent.…”

“…In Malawi, cefdinir, but not amoxicillin, was associated with increased weight gain, as compared with placebo. 15 Our study has several key limitations. First, we assumed a likelihood of nutritional recovery of 80%, which was not achieved, and we cannot rule out the possibility that amoxicillin had a protective effect of 12% or a harmful effect of 1% on nutritional recovery.…”

“…The findings from that well-conducted trial in Malawi, reported in 2013, added important evidence to inform international guidance, but the high-risk study population, characterized by a high burden of kwashiorkor and human immunodeficiency virus (HIV) infection, makes it difficult to generalize the findings. 15 The programmatic costs and public health consequences of emerging antibiotic resistance associated with routine antibiotic use require more evidence to support continued practice. We present the results of a randomized, double-blind, placebo-controlled trial in Niger that assessed the effect of routine amoxicillin use on nutritional recovery in children with severe acute malnutrition.…”

Management of severe acute malnutrition

“…antimalarial treatment for malaria and metronidazole for gastrointestinal infections and infestations. [7,8,19,25] Correction of micronutrient deficiencies Vitamin and mineral deficiencies are common in malnutrition. Supplementation (Table 2) should be given for at least 2 weeks.…”

Antibiotic resistant bacteria in terrestrial and aquatic environments: A review

“…In the last 60 years, they have become a mainstay of the physician's arsenal for fighting bacterial infections in humans, and deaths from such infections have become much less common, at least in countries where antibiotics and good health care are available. Recently it has also been found that antibiotic compounds can be of great utility in treating severe malnutrition [2][3]. Less well-known among the general public are the uses of antibiotic compounds in plant agriculture, in aquaculture, for therapy and prophylaxis in veterinary medicine, and for growth promotion of animals, mainly cattle and poultry [4][5].…”