Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children

Isanaka, Sheila; Langendorf, Céline; Berthé, Fatou; Gnegne, Smaila; Li, Nan; Ousmane, Nassirou; Harouna, Souley; Hassane, Hamidine; Schaefer, Myrto; Adéhossi, Eric; Grais, Rebecca F.

doi:10.1056/nejmoa1507024

Cited by 102 publications

(134 citation statements)

References 21 publications

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“…Observed weight and MUAC gains were consistent with other community-based nutritional programs in which mean weight gain varied between 3.0 and 6.8 g $ kg 21 $ d 21 (20) and mean MUAC gain varied between 0.3 and 0.6 mm/d (21,22) during recovery. Response to treatment was also similar to those recorded in children enrolled in a randomized trial in the same setting in which a weekly distribution of RUTF and standard medical care was provided (Table 3) (17). The favorable treatment responses noted in our study cohort thus suggest the clinical safety of a monthly RUTF distribution in the management of uncomplicated SAM.…”

Section: Discussionsupporting

confidence: 77%

Outpatient treatment of severe acute malnutrition: response to treatment with a reduced schedule of therapeutic food distribution ,

Isanaka

Kodish²,

Berthé

et al. 2017

The American Journal of Clinical Nutrition

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Background: Community-based management of severe acute malnutrition (SAM) has been shown to be safe and cost-effective, but program coverage remains low. Treatment models that maintain high levels of clinical effectiveness but allow for increased coverage are still needed. A reduced schedule of follow-up, in which children receive clinical follow-up and therapeutic foods on a monthly rather than weekly basis, may be one alternative. Objective: We aimed to describe the safety and feasibility of a monthly distribution of ready-to-use therapeutic food (RUTF) in the treatment of uncomplicated SAM, in terms of clinical response to treatment and household RUTF use. Design: We conducted a nonrandomized pilot intervention study in which 115 children eligible for outpatient treatment of SAM were provided a monthly ration of RUTF. Anthropometric measurements were taken weekly for 4 wk to monitor treatment response. Unannounced household spot checks were conducted over 4 wk to assess household use of RUTF and storage practices. Results: Adequate weight and midupper arm circumference (MUAC) gain were found throughout the 4-wk follow-up period. Observed mean 6 SD weight gain from admission was 9.8 6 6.8 g $ kg 21 $ d 21 in week 1 and 4.2 6 2.1 g $ kg 21 $ d 21 by week 4. Unplanned household spot checks found an average surplus of RUTF sachets compared with the number expected based on the date of distribution and recommended dosing throughout the 4 wk of follow-up. The frequency at which more than the recommended dose was used (i.e., deviance of .2 sachets between available and expected stocks) was 4% and 22% of households visited in week 1 and week 4, respectively. Conclusion: Adequate treatment response and RUTF use in the outpatient treatment of SAM was maintained over 4 wk of follow-up with a monthly schedule of RUTF distribution. This study was registered at clinicaltrials.gov as NCT02994212. Am J Clin Nutr 2017;105:1191-7.

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Section: Discussionsupporting

confidence: 77%

Outpatient treatment of severe acute malnutrition: response to treatment with a reduced schedule of therapeutic food distribution ,

Isanaka

Kodish²,

Berthé

et al. 2017

The American Journal of Clinical Nutrition

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“…More recent data confirmed the weak impact of amoxicillin on human gut microbiota 22. The powerlessness of amoxicillin in modulating gut microbiota may explain its ineffectiveness in providing nutritional recovery from severe malnutrition, which was recently observed in a large cohort of African children 23. However, a β-lactam combination, including ampicillin and cephalosporins, led to a decrease in Firmicutes and an increase in Bacteroidetes and Proteobacteria (particularly Enterobacteriaceae , which are commonly resistant to β-lactam antibiotics) and reduced microbial richness 24.…”

Section: Effects Of Antibiotics On Gut Microbiota Compositionmentioning

confidence: 65%

“…These results have been confirmed also in a recent systematic review, which found any antibiotic exposure during infancy as a risk factor for overweight later in childhood 133. Nevertheless, some recent papers did not confirm the association between early-life antibiotic administration and later weight gain 23 134. Differences in populations (including age and geography) and in drugs features (antibiotic classes, dosages, number of courses) may explain this disagreement.…”

Section: Effects Of Antibiotics On Non-communicable Disordersmentioning

confidence: 81%

Antibiotics as deep modulators of gut microbiota: between good and evil

Ianiro

Tilg

Gasbarrini

2016

Gut

515

371

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“…35 Antihelminthics may be offered for deworming, but there is no consensus on their role in undernutrition. 23 Box 2: screening criteria for severe acute malnutrition 5 screening criteria for children aged 6-59 months Any of the following: …”

Section: Medicinesmentioning

confidence: 99%