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Antibiotics improved efficacy of therapeutic regimen for severe malnutrition in children
Children with severe acute malnutrition who received antibiotics in addition to ready-to-use therapeutic food had better recovery and mortality rates than children given food alone in a recent study.
In a double blind trial, researchers randomly assigned 2,767 severely malnourished Malawian children aged 6 to 59 months to receive either amoxicillin (n=924), cefdinir (n=923) or placebo (n=920) for 7 days, along with ready-to-use therapeutic food.
Nutritional recovery occurred in 88.3% of the population, including 88.7% of the amoxicillin group, 90.9% of the cefdinir group and 85.1% of placebo patients. Investigators calculated the RR for treatment failure as 1.32 (95% CI, 1.04-1.68) for placebo compared with amoxicillin and 1.64 (95% CI, 1.27-2.11) compared with cefdinir. Weight gain also was accelerated for patients treated with antibiotics.
Death occurred in 5.4% of the cohort, including 4.8%, 4.1% and 7.4% of amoxicillin, cefdinir and placebo recipients, respectively. Mortality risk was higher among placebo patients than the amoxicillin (RR=1.55; 95% CI, 1.07-2.24) or cefdinir groups (RR=1.80; 95% CI, 1.22-2.64).
Factors independently associated with nutritional recovery via multivariate analysis included cefdinir (OR=1.69, 1.24-2.31) or amoxicillin use (OR=1.38, 1.02-1.86) compared with placebo; kwashiorkor (OR=5.88, 4.15-8.33) or marasmus (OR=1.74, 1.22-2.47) compared with marasmic kwashiorkor, and older age (OR=1.007, 1.001-1.017 per 1-month increase). Each factor was significantly associated with reduced mortality, while HIV seropositivity in the mother or child and a cough within 2 weeks of enrollment increased the risk for treatment failure and death.
“We found that the routine addition of amoxicillin or cefdinir to the outpatient management of severe acute malnutrition was associated with marked improvements in recovery and mortality rates, and significant improvements in weight and gain in the mid-upper-arm circumference,” the researchers wrote, adding that trial results supplanted their previous research that indicated no benefit from amoxicillin. “Further studies are needed to evaluate long-term outcomes of routine antibiotic use in [this population], and to determine whether a specific high-risk target population can be better defined.”
Disclosure: See the study for a full list of relevant disclosures.