Do children with uncomplicated severe acute malnutrition need antibiotics?
The evidence underlying current antibiotic recommendations for uncomplicated severe acute malnutrition (SAM) is weak. Susceptibility- studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable monitoring, we believe that there is sufficient equipoise for placebo controlled RCTs, the only robust way to demonstrate true efficacy.
Children suffering from SAM are often treated with antibiotics according to WHO guidelines. In the case of children with uncomplicated SAM, the evidence behind recommendation may be reconsidered. This review aimed to assess the evidence, forty-five studies were included without geographical limitation, assessed using international guidelines. Results found the evidence supporting antibiotic treatment of uncomplicated SAM to be weak. Amoxicillin was found to be favoured over cotrimoxazole. Further research is required in the routine use of antibiotics to treat SAM, to provide more in depth, robust evidence.
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