Bulletin of the World Health Organization

Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics

Marzia Lazzerini & David Tickell

Volume 89, Number 8, August 2011, 594-607

Table 1. Incidence of bacterial infections in children with severe acute malnutrition

Year Country No. of children (% HIV+) Grade of malnutrition Bacteraemia (%) LRTI (%) UTI (%) Isolated bacteria Antibiotic resistance in vitroa
TMP-SMX Clavul Ampi Genta CAF Ceph Cipro
2006 United Republic of Tanzania9 781 (19) Severe 3 17 8 NR
2006 Kenya9 340 (9) Severe 5 7 NR
2006 Uganda10 450 (36) Severe 17 Salmonella typhimurium, Staphylococcus aureus, Salmonella enteritidis, Streptococcus pneumoniae +++ ++ ++
2006 Uganda11 315 (39) Severe 18 68 26 NR
2006 Uganda12 134 (44) Severe 22 Salmonella spp, Escherichia coli +++ +++ ++ ++
2005 Kenya13 91 (43) Severe 29 Coagulase-negative staphylococci ++ ++ ++ ++
2002 Nigeria14 194 (NR) Severe 11.3 Escherichia coli, Klebsiella spp, Pseudomonas spp +++ +++ + ++/+++
2001 Congo15 Unclear Severe 13.2 Enterobacteriaceae ++ ++ ++
2001 Jamaica16 150 (NR) Mod-severe 10 Coagulase-negative staphylococci + + +
2000 Malawi17 75 (25) Severe 9 17 Streptococcus pneumoniae, Klebsiella spp, Escherichia coli
2000 Turkey18 103 (NR) All 31 Escherichia coli, Klebsiella spp, Proteus spp +++ + +
1996 South Africa19 323 (NR) Severe 9.6 Gram-negative enteric bacilli
1995 South Africa20 134 (NR) Severe 26 Gram-negative enteric bacilli
1994 Gambia21 378b (NR) All 28 Streptococcus pneumoniae, Haemophilus spp
1992 South Africa22 134 (NR) NR 26 NR
1992 United Republic of Tanzania23 164 (NR) Severe Infections at admission: 92%
In-hospital infections: 49%
Staphylococcus aureus, Escherichia coli, Klebsiella spp, Enterococcus faecalis, Escherichia coli

Ampi, ampicillin; CAF, chloramphenicol; Ceph, cephalosporin (ceftriaxone; cefotaxime, ceftazidime); Cipro, ciprofloxacin; Clavul, amoxicillin and clavulanic acid; Genta, gentamicin; LRTI, lower respiratory tract infection; NR, not reported; spp, species; TMP-SMX, corimoxazole; UTI, urinary tract infection.

a + > 20%; ++ > 50%; +++ > 75%.

b Children with pneumonia.