Antibiotics help severely malnourished children recover

Feb 7 2013

By Helen Albert, Senior medwireNews Reporter

Giving severely malnourished children antibiotics in addition to nutritional therapy significantly improves their chances of making a full recovery compared with nutritional therapy alone, say researchers.

They explain that children with severe malnutrition are at increased risk for bacterial infection and that the addition of antibiotics versus placebo to standard nutritional therapy significantly improved recovery rates by 3.6-5.8 percentage points, as well as mortality rates by 2.6-3.3 percentage points, depending on the type of antibiotic prescribed.

Writing in the New England Journal of Medicine, Mark Manary (Washington University, St Louis, Missouri, USA) and colleagues report the results from a study of 2767 severely malnourished children in Malawi, aged 6-59 months, who were given amoxicillin (80-90 mg/kg per day in suspension; n=924), cefdinir (14 mg/kg per day in suspension; n=923), or placebo (n=920) for 7 days in addition to nutritional therapy.

The nutritional therapy consisted of ready-to-use therapeutic food - a fortified spread made of peanut paste, powdered milk, oil, sugar, and a micronutrient supplement.

The children were followed up at 2-weekly intervals to assess their progress. Over a mean period of 41 days, 88.7%, 90.9%, and 85.1% of the children in the amoxicillin, cefdinir, and placebo groups recovered, respectively.

The risk for treatment failure (child still malnourished at 6 months) decreased by 32% and 64% when amoxicillin and cefdinir, respectively, were compared with placebo treatment.

Similarly, the risk for death for the children given placebo compared with the respective antibiotics increased 1.55- and 1.80-fold.

Antibiotic use also seemed to improve the rate of weight gain in children who recovered, notes the team.

International consensus guidelines recommend use of ready-to-use therapeutic foods for children with uncomplicated severe malnutrition, but "despite the markedly better outcomes observed with this revised outpatient regimen, 10 to 15% of children still do not recover," say Manary et al.

Based on the results of this study, the researchers therefore suggest that "the routine inclusion of antibiotics as part of their nutritional therapy is warranted."

However, they conclude: "Further studies are needed to evaluate long-term outcomes of routine antibiotic use in children with uncomplicated severe acute malnutrition and to determine whether a specific high-risk target population can be better defined."

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