e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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

Intervention | Last updated: 9 August 2023

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.



Evidence

Systematic reviews used to develop the guidelines

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review

Picot J, Hartwell D , Harris P, Mendes D, Clegg AJ, and Takeda A. Health Technology Assessment. 2012; Vol.16:No.19(for Guideline: Updates on the management of severe acute malnutrition in infants and children).

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

Lazzerini M, Tickell D. Bulletin of the World Health Organization. 2011; 89(8):593–606.

Related systematic reviews

Do children with uncomplicated severe acute malnutrition need antibiotics? A systematic review and meta-analysis

Alcoba G, Kerac M, Breysse S, Salpeteur C, Galetto-Lacour A, Briend A, Gervaix A. PLoS One. 2013; 8(1):e53184.

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Cost-effectiveness analyses

The analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG. Health Policy Plan. 2012; 27(2):127-37.

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M. Washington DC: Results for Development Institute; 2015.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K. Cost Eff Resour Alloc. 2012; 10:4.

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO. Cost Eff Resour Alloc. 2009 Jan; 7:2.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M. Health Policy Plan. 2013; 28(4):386-99.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al. PLoS One. 2018; 13(11):e0205688.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J. Health. 2014; 6: 886-899.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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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.

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