Use of antibiotics in the outpatient management of children 6-59 months of age with severe acute malnutrition

In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

Children with severe acute malnutrition may be more susceptible to infection and studies have documented the high prevalence of pneumonia, bacteraemia and urinary tract infections in severely malnourished children. However, as severe acute malnutrition suppresses the immune response, it may be difficult to detect infection.

Previous recommendations were that all children with severe acute malnutrition should be admitted to hospital and treated with a course of antibiotics. However, the availability of ready-to-use-therapeutic foods now allows for the outpatient treatment of large numbers of children who have severe acute malnutrition but who do not have medical complications. Many children being treated as outpatients still have or may be susceptible to infection.