Antibiotics in severely malnourished children

Added March 9, 2018

Citation: Lazzerini M., Tickell D. Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics. Bulletin of the World Health Organization 2011;89(8):593-606

The use of broad-spectrum antibiotics for children with severe acute malnutrition (SAM) is supported by epidemiological data demonstrating a high prevalence of infections in these children, but clinical studies are lacking. Evidence supports the use of amoxicillin as a first-line treatment option.

Malnutrition presents an issue in many low and middle-income countries, SAM can be life threatening and, if untreated, is fatal in 30-50% of cases for hospitalized children. This review examined 23 studies evaluating the efficacy, safety and pharmacokinetics (PK) of antibiotics in children with severe acute malnutrition. Trial quality was considered poor and results were unable to be pooled due to lack of homogeneity.  The results of this review concluded that amoxicillin showed no benefit in treating uncomplicated SAM, compared to a placebo. Standardized use of ampicillin and gentamicin significantly reduced mortality rates in hospitalized children. Oral amoxicillin for 5 days was as effective as intramuscular ceftriaxone for 2 days. Oral chloramphenicol was as effective as trimethoprim-sulfamethoxazole in children with pneumonia. Evidence examined in this trial was not strong enough to make further recommendations on the use of antibiotics in the treatment of SAM.

 

Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence the prevention and treatment of malnutrition but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about prevention or treatment of malnutirition on the basis of this summary alone.

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