Does Routine Antibiotic Therapy Benefit Children With Severe Acute Malnutrition?: Pediatricians Viewpoint.

In this double-blind, placebo-controlled trial, the authors randomly assigned children (age 6-59 mo) with uncomplicated severe acute malnutrition (SAM) to receive amoxicillin or placebo for 7 days. The primary outcome was nutritional recovery at or before week 8. A total of 2412 children were randomized, and 2399 children were included in the analysis. Nutritional recovery occurred in 65.9% of children in the amoxicillin group (790 of 1199) and in 62.7% of children in the placebo group (752 of 1200). There was no significant difference in the likelihood of nutritional recovery (RR 1.05; 95% CI 0.99, 1.12; P=0.10). In secondary analyses, amoxicillin decreased the risk of transfer to inpatient care by 14% (26.4% in the amoxicillin group vs. 30.7% in the placebo group; RR 0.86; 95% CI 0.76, 0.98; P=0.02). The authors found no benefit of routine antibiotic use with respect to nutritional recovery from uncomplicated SAM, and concluded that in regions with adequate infrastructure for surveillance and management of complications, health care facilities could consider eliminating the routine use of antibiotics in protocols for the treatment of uncomplicated severe acute malnutrition.