Routine antibiotics should be reconsidered for malnourished children

February 3, 2016

A new study suggests that the current recommendation to treat severely malnourished children with routine antibiotics does not increase the likelihood of nutritional recovery in uncomplicated cases. Given this finding, the study's authors say that routinely using antibiotics may not be necessary or beneficial for severely malnourished children being treated at home when there is adequate local health infrastructure.

Reducing routine antibiotic use would be prudent given global concern over the problem of antibiotic resistance, say the researchers.

The study will appear in the February 4, 2016 issue of the New England Journal of Medicine (NEJM).

The new findings challenge the World Health Organization's (WHO) current guidelines that with uncomplicated severe acute malnutrition (SAM) always be given , whether or not they need them.

"Our results from Niger were surprising, as they challenge the current WHO recommendations and a recent well-conducted trial from Malawi. It's an exciting step forward though, as we hope that this new evidence will motivate a deeper review of current recommendations and the evidence on which they are based," said Sheila Isanaka, assistant professor of nutrition at Harvard T.H. Chan School of Public Health and lead author of the study.

SAM contributes to high child mortality in many places throughout the world, affecting about 34 million children under age 5. Bacterial infection can complicate advanced cases, so WHO recommended in 1999 that all children with SAM—all treated in hospitals at the time—be given antibiotics to reduce the risk of death. But recent developments in how SAM is treated have resulted in greater numbers of children diagnosed with SAM and more children treated at home before they're seriously ill, instead of in the hospital. These changes have raised the question of whether it's still necessary to routinely use antibiotics in all SAM cases treated at home.

For the new study, Isanaka—along with colleagues from Epicentre, Médecins sans Frontières (Doctors Without Borders), UNICEF, and the Ministry of Health of Niger, among others—looked at 2,399 children in rural Niger from ages 6-59 months who had uncomplicated SAM. They randomly assigned the children to receive either amoxicillin or a placebo for seven days.

They found that, among the children who received amoxicillin, 65.9% recovered, while 62.7% recovered in the placebo group—meaning that there was no significant difference in the likelihood of recovery between the groups.

The authors noted that forgoing routine use of antibiotics in settings with adequate medical infrastructure could simplify treatment protocols by eliminating the need for a health professional to prescribe the drugs. Instead, community workers could oversee treatment—which would make it easier for more severely to receive care, even in remote villages.

Harvard Chan School's Nan Li, research scientist, also participated in the study.

Explore further: University's research key in new international guidelines for treatment of severe malnutrition

More information: "Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children," Sheila Isanaka, Céline Langendorf, Fatou Berthé, Smaila Gnegne, Nan Li, Nassirou Ousmane, Souley Harouna, Hamidine Hassane, Myrto Schaefer, Eric Adehossi, and Rebecca F. Grais, NEJM, online February 3, 2016, DOI: 10.1056/NEJMoa1507024

Related Stories

University's research key in new international guidelines for treatment of severe malnutrition

December 6, 2013
The World Health Organization (WHO) has released new guidelines for the treatment of severe acute malnutrition, based in large part on research at Washington University School of Medicine in St. Louis.

Antibiotics cut death rate for malnourished children

January 30, 2013
Severely malnourished children are far more likely to recover and survive when given antibiotics along with a therapeutic peanut-based food than children who are simply treated with the therapeutic food alone, researchers ...

Antibiotics influence childhood weight gain

December 2, 2015
Kids who take antibiotics during childhood gain weight faster than those who do not, according to Johns Hopkins Bloomberg School of Public Health research. Still, antibiotics are necessary in some cases.

Antibiotic use in early life disrupt normal gut microbiota development

January 26, 2016
The use of antibiotics in early childhood interferes with normal development of the intestinal microbiota, shows research conducted at the University of Helsinki. Particularly the broad-spectrum macrolide antibiotics, commonly ...

Black children less likely to be prescribed antibiotics

March 18, 2013
(HealthDay)—Black children are less likely to be prescribed antibiotics and to be diagnosed with conditions that require antibiotics, even when treated by the same doctor, according to research published online March 18 ...

Recommended for you

Is rushing your child to the ER the right response?

October 16, 2017
If a child gets a small burn from a hot pan, starts choking or swallows medication, parents may struggle to decide whether to provide first aid at home or rush them to the hospital, suggests a new national poll.

Happier mealtimes, healthier eating for kids

October 13, 2017
(HealthDay)—Parents who struggle to get their children to follow a healthy diet may want to make dinnertime a pleasant experience, new research suggests.

Children born prematurely have greater risk of cognitive difficulties later in life

October 11, 2017
Babies born preterm have a greater risk of developing cognitive, motor and behavioural difficulties and these problems persist throughout school years, finds a new study led by Queen Mary University of London (QMUL).

Helping preemies avoid unnecessary antibiotics

October 5, 2017
(HealthDay)—Researchers say they have identified three criteria that suggest an extremely premature infant has a low risk of developing sepsis, which might allow doctors to spare these babies early exposure to antibiotics.

Got a picky eater? How 'nature and nurture' may be influencing eating behavior in young children

October 3, 2017
For most preschool-age children, picky eating is just a normal part of growing up. But for others, behaviors such as insisting on only eating their favorite food item—think chicken nuggets at every meal—or refusing to ...

Anxious moms may give clues about how anxiety develops

September 27, 2017
Moms may be notorious worriers, but babies of anxious mothers may also spend more time focusing on threats in their environment, according to a team of researchers.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.