e-Library of Evidence for Nutrition Actions (eLENA)

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.

WHO recommendations

Children who are 6-59 months of age with uncomplicated severe acute malnutrition, not requiring to be admitted and who are managed as outpatients, should be given a course of oral antibiotic, such as amoxicillin.

Children who are 6-59 months of age who are undernourished but who do not have severe acute malnutrition should not routinely receive antibiotics unless they show signs of clinical infection.


This is a summary of one of several WHO recommendations on the management of SAM in infants and children. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines and guidance documents under ‘WHO documents’ below.

WHO documents

WHO documents

GRC-approved guidelines
Other guidance documents


Systematic reviews used to develop the guidelines
Related systematic reviews
Clinical trials

Last update:

24 August 2016 17:01 CEST

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

Global targets

Implementation of this intervention may contribute to the achievement of the following targets:

Global nutrition targets

Target 6: Reduce and maintain childhood wasting to less than 5%