Antibiotics in severely malnourished children

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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.

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