Treating malnutrition with antibioticsBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f694 (Published 06 February 2013) Cite this as: BMJ 2013;346:f694
Severe malnutrition compromises children’s defence against infections. Do malnourished children need antibiotics as well as food supplements? In a trial from Malawi, children given a week of antibiotics were more likely to recover from acute severe malnutrition and less likely to die than controls given a placebo. The authors say consensus guidelines by global agencies such as the World Health Organization seem to be right. Outpatient treatment for acute kwashiorkor, marasmus, or both should include antibiotics⇑.
The trial compared amoxicillin or cefdinir with placebo in 2767 young children who presented to feeding centres with uncomplicated but severe malnutrition, most commonly kwashiorkor. A fifth of those tested had HIV. About 60% of children had a fever at baseline, just over half had a cough, and just under half had diarrhoea. They all received therapeutic food supplements and returned to the centre every fortnight for up to 12 weeks.
Amoxicillin and cefdinir worked equally well. Both boosted the chance of recovery significantly (88.7% for children given amoxicillin v 90.9% for cefdinir v 85.1% for placebo) and reduced the risk of death significantly (4.8% v 4.1% v 7.4%) compared with placebo. Adherence was good. Three children had adverse reactions to their antibiotics. None of these reactions was serious.
These results are clear cut enough to justify routine use of antibiotics in this setting, despite the well known threat of antimicrobial resistance, say the authors.
Cite this as: BMJ 2013;356:f694