Antibiotics improved outcomes in children with malnutrition

In the treatment of uncomplicated severe acute malnutrition, the addition of antibiotics to therapeutic regimens was linked to an improvement in recovery and mortality rates in children, according to data recently published.

In the December 2009 to January 2011 trial of 2,767 Malawian children aged 6 to 59 months, participants met the following criteria: edema (indicative of kwashiorkor); a weight-for-height z score of less than –3 (indicative of marasmus); or both (marasmic kwashiorkor). The children were randomly assigned to receive amoxicillin (n=924 children), cefdinir (n=923) or placebo (n=920) for 7 days in addition to ready-to-use therapeutic food for the outpatient treatment of uncomplicated severe acute malnutrition, according to the study findings published in The New England Journal of Medicine.

Researchers said in the amoxicillin, cefdinir and placebo groups, 88.7%, 90.9% and 85.1% of the children recovered, respectively. The mortality rates for the three groups were 4.8%, 4.1% and 7.4%, respectively.

The rate of weight gain also increased in those children who received antibiotics.

Researchers said most (88.3%) of the children enrolled in the study recovered from severe acute malnutrition. Children with marasmic kwashiorkor recovered less frequently and had higher mortality rates than children with either kwashiorkor or marasmus.

The overall mortality rate was 5.4%, but the rate was significantly higher among children who received placebo than among those who received either amoxicillin or cefdinir.

Younger age, marasmic kwashiorkor, greater stunting, HIV exposure or infection, and a cough before enrollment were associated with an increased risk of treatment failure, according to a multiple logistic-regression model for baseline and intervention characteristics associated with nutritional recovery. Those factors were significantly correlated with an increased risk of death; however, the caretaker’s report of a good appetite at enrollment also correlated with a reduced risk of death.

Researchers said three adverse events presumed to be drug reactions were reported: a generalized popular rash in a child who received amoxicillin; thrush in a child who received cefdinir; and bloody diarrhea that resolved spontaneously while treatment continued in a child who received cefdinir.

Disclosure: The study was funded by a grant from the Hickey Family Foundation, a cooperative agreement with the Academy for Educational Development Food and Nutrition Technical Assistance 2 project, and grants from the NIH.