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 2. Studies on efficacy and safety of antibiotics in children with severe acute malnutrition

Reference Design (Risk of bias) Population Intervention groups Outcomes
Group 1
n (%)
Group 2
n (%)
Trehan et al. 201026 – Retrospective (high)
– Setting: Malawi
– Years: 2003–2005
(n = 2 453)
– Inclusion criteria: age 6–59 months, no complications
– Exclusion criteria: poor appetite, altered mental status, low perfusion or respiratory distress
1. Amoxicillin 60 mg/kg/day, 7 days
2. Nothing
Recovered at 4 weeks
Recovered at 12 weeks
Died at 4 weeks
Died at 12 weeks
Defaulted at 4 weeks
Defaulted at 12 weeks
198 (39.8)
417 (83.7)
10 (2)
13 (2.6)
26 (5.2)
39 (7.8)
1385 (70.8)*
1 673 (85.6)
26 (1.3)
34 (1.7)
121 (6.2)
182 (9.3)
Dubray et al. 200827 – RCT (low)
– Setting: Sudan
– Years: 2002–2003
(n = 458)
– Inclusion criteria: age 6–59 months
– Exclusion criteria: refuse, study drugs in the 7 days before, hypersensitivity, used a different drug, vomiting, convulsion, impaired consciousness, otitis
1. Ceftriaxone 75 mg/kg once daily IM, 2 days
2. Amoxicillin 40 mg/kg twice daily oral, 5 days
WG > 10 g/kg/day (ITT)
WG > 10 g/kg/day (PP)
Recovered
Died
Defaulted
Referred
Length of stay (days)
Adverse event
123 (53.5)
89 (63.1)
161 (70)
9 (3.9)
39 (17)
4 (1.7)
33.5
8 (4)
127 (55.7)
88 (62.9)
170 (74.6)
7 (3.1)
43 (18.9)
2 (0.9)
31.4
2 (1)*
Wilkinson et al. 199628 – Pre and after study (high)
– Setting: South Africa
– Years: 1992–1993
(n = 300)
– Inclusion criteria: hospitalized
– Exclusion criteria: not reported
1. No standard regimen (Waterlow protocol 1993)
2. Ampicillin (7 days orally, IV for sick children) Gentamicin (5 days IM), Glycaemia controls
Death 32 (20) 8 (6)*
Mulholland et al. 199521 – RCT (medium)
– Setting: Gambia
– Years: 1990–1992
(n = 144)
– Inclusion criteria: aged < 5 years, radiological evidence of pneumonia
1. Chloramphenicol 25 mg/kg 8-hourly oral
2. TMP-SMX 40/200 mg twice daily (< 1 year old), 60/300mg twice daily (> 1 year old)
Recovered
Improved
Failure
Died
21 (28)
19 (27)
16 (26)
4 (5.4)
20 (28)
19 (27)
16 (26)
8 (11.2)
Golden et al. 200029 – Retrospective (high)
– Setting: 9 countries in SSA (unspecified)
– Years: 1994–1997
(n unspecified)
– Inclusion criteria: aged 6–59 months, admitted to TFC
Any antibiotic on admission Negative association (r2 = 0.37; P = 0.002) between mortality ratio (observed mortality divided for expected mortality as for Prudhon index) and antibiotic ratio (proportion of children given antibiotics from admission).

IM, intramuscular; ITT, intention to treat analysis; PP, per protocol analysis; RCT, randomized controlled trial; SSA, Sub-Saharan Africa; TFC, therapeutic feeding centre; TMP–SMX, trimethoprim-sulfamethoxazole; WG, weight gain; * P < 0.001.