Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children

Approximately 19 million children under the age of 5 worldwide suffer from severe acute malnutrition. This condition contributes greatly to mortality and disease burden among children. In order to reduce the risk of death from severe acute malnutrition, nutritional and medical intervention is required. Furthermore, bacterial infection can complicate cases of severe acute malnutrition, since the risk of infection is high. For this reason, in 1999 the World Health Organization (WHO) recommended the routine use of broad spectrum antibiotics for the management of severe acute malnutrition. More recent statistics show that malnutrition is 4 to 5 times as high as the number before the introduction of standards of treatment. Despite the recent developments, there has been no strong evidence about whether the use of the same medical protocol for community based regimens should be used. Thus, researchers conducted a randomized, double-blind, placebo-controlled trial in Niger to examine the effect of routine amoxicillin use on nutritional recovery in children with severe acute malnutrition.

Overall, 64% of the children enrolled in the study recovered from severe acute malnutrition. However, these results did not significantly indicate that routine provision of amoxicillin was superior to placebo for nutritional recovery in children with uncomplicated severe acute malnutrition. First, Amoxicillin reduced the risk of hospitalization when compared to placebo, but about 53% of children transferred to inpatient care were admitted to the hospital for malnutrition. Next, among hospitalized children, there was no significant differences in mean of stay between the placebo group and intervention group, but both groups recovered at the same times. Despite these findings, researchers were able to conclude that amoxicillin reduced the risk of transfers to inpatient care due to complicated gastroenteritis and showed benefits over short-term weight gain.

From this study, it seems that overall Amoxicillin did not show superiority to placebo treatment. These findings challenge the view that routine antibiotic therapy is always necessary or beneficial for the treatment of severe acute malnutrition. Eliminating the use of Amoxicillin could help simplify the treatment regimen, which would result in increased cost savings associated with drugs, staff, and systems for delivery. In addition, there are multiple factors that can be costly to treat, such infections that result from resistance to antibiotic regimens. I believe that it’s good that these researchers decided to check the treatment guidelines for using amoxicillin, because determining the true value of the regimen and be greatly beneficial for the future treatment of severe acute malnutrition. Do you believe it is important to routinely research established treatment guidelines? Why or why not? Are you aware of any treatment guidelines that have been updated in the past few years?

Isanaka S, Langendorf C, Berthe F et al. Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children. N Engl J Med. 2016; 374:444-453