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Title: Evaluation of the routine use of amoxicillin as part of the home-based treatment of severe acute malnutrition

Author
item TREHAN, INDI - Washington University School Of Medicine
item AMTHOR, RACHEL - Washington University School Of Medicine
item MALETA, KENNETH - University Of Malawi
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: Tropical Medicine and International Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/9/2010
Publication Date: 9/1/2010
Citation: Trehan, I., Amthor, R.E., Maleta, K., Manary, M.J. 2010. Evaluation of the routine use of amoxicillin as part of the home-based treatment of severe acute malnutrition. Tropical Medicine and International Health. 15(9):1022-1028.

Interpretive Summary: While international guidelines recommend antibiotic use along with therapeutic feeding for treatment of severe acute malnutrition, the use of antibiotics in outpatient feeding programs has not been adequately examined. This study compared the recovery of children in a feeding program receiving one week of amoxicillin to children in a similar feeding program without antibiotics in order to determine whether amoxicillin use is associated with better recovery rates in home based SAM treatment. At twelve weeks, the recovery rate for children who were treated with amoxicillin was 84% as compared to 86% for children treated without antibiotics. Evidence from this study supports the efficacy of ready-to-use therapeutic foods in helping children recover from severe malnutrition. This information also suggests that children with SAM treated without antibiotics do not have an inferior rate of recovery.

Technical Abstract: To determine whether the inclusion of amoxicillin correlates with better recovery rates in the home-based treatment of severe acute malnutrition with ready-to-use therapeutic food. This retrospective cohort study compared data from the treatment of two groups of children in Malawi aged 6-59 months with uncomplicated severe acute malnutrition. The standard protocol group received a 7-day course of amoxicillin at the onset of treatment. The alternate protocol group received no antibiotics. All children were treated with the same ready-to-use therapeutic food. The primary outcome was nutritional recovery, defined as achieving a weight-for-height Z-score > -2 without oedema. Four hundred and ninety-eight children were treated according to the standard protocol with amoxicillin, and 1955 were treated under the alternate protocol without antibiotics. The group of children treated with amoxicillin was slightly older and more stunted at baseline. The recovery rate for children who received amoxicillin was worse at 4 weeks (40%vs. 71%), but similar after up to 12 weeks of therapy (84%vs. 86%), compared to the children treated without antibiotics. Regression modelling indicated that this difference at 4 weeks was most strongly associated with the receipt of amoxicillin. This review of two therapeutic feeding programs suggests that children with severe acute malnutrition who were treated without amoxicillin did not have an inferior rate of recovery. Given the limitations of this retrospective analysis, a prospective trial is warranted to determine the effect of antibiotics on recovery from uncomplicated malnutrition with home-based therapy.