Location: Children's Nutrition Research CenterTitle: Antibiotics as part of the management of severe acute malnutrition Author
Submitted to: New England Journal of Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/10/2012
Publication Date: 1/31/2013
Citation: Trehan, I., Goldbach, H.S., LaGrone, L.N., Meuli, G.J., Wang, R.J., Maleta, K.M., Manary, M.J. 2013. Antibiotics as part of the management of severe acute malnutrition. New England Journal of Medicine. 368(5):425-435. Interpretive Summary: Adding routine antibiotics to nutritional therapy may increase recovery rates and decrease mortality among children with severe acute malnutrition. This study compared the recovery of children treated with a ready to use therapeutic food and a 7-day course of amoxicillin, cefdinir, or placebo. Among those children who recovered, those who received antibiotics were less likely to die and gained weight at a faster rate. The addition of antibiotics to the treatment regimen for children diagnosed with severe acute malnutrition was associated with an improvement in recovery and mortality rates.
Technical Abstract: 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. 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. 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. The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates.