February 04, 2016
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Routine antibiotics do not benefit children with malnutrition

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The administration of routine antibiotics to children with uncomplicated severe acute malnutrition did not significantly aid in nutritional recovery in a double-blind, placebo-controlled trial conducted in Niger.

“In regions with adequate infrastructure for surveillance and management of complications, health care facilities could consider eliminating the routine use of antibiotics in protocols for the treatment of uncomplicated severe acute malnutrition,” Sheila Isanaka, ScD, from the Harvard T.H. Chan School of Public Health, Boston, and colleagues, wrote.

At four different health centers located in Madarounfa, a rural health district in Niger, researchers randomly assigned 2,412 children with uncomplicated severe acute malnutrition to receive amoxicillin (80 mg/kg of body weight per day, twice daily) or placebo for 7 days. The children were aged 6 to 59 months and lived within 15 km of each center. The final analysis included 2,399 children. The primary outcome of nutritional recovery was evaluated at or before week 8. Amoxicillin was chosen due to being within the current national guidelines in Niger.

No significant difference was found regarding the likelihood of nutritional recovery in the amoxicillin group (65.9% recovered), compared with the placebo group (62.7%; risk ratio = 1.05; 95% CI, 0.99-1.12)

In a secondary analysis, the risk for transfer to inpatient care decreased in the amoxicillin group by 14% compared with the placebo group (26.4% vs. 30.7%; risk ratio = 0.86; 95% CI, 0.76-0.98).

“Children in both groups recovered quickly, suggesting that adequate inpatient care may mitigate any risk associated with the absence of routine antibiotic use,” the researchers wrote. … “We found that routine provision of amoxicillin was not superior to placebo for nutritional recovery in children with uncomplicated severe acute malnutrition. This finding challenges the view that routine antibiotic therapy is always necessary or beneficial. Considering the burden of infection and limitations in the local capacity for adequate medical follow-up, eliminating routine antibiotic use could represent an important simplification of treatment, resulting in substantial cost savings with respect to drugs, staff and systems for delivery and encouraging expanded service provision and responsible antibiotic stewardship,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

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