title: Treatment of severe malnutrition with 2-day intramuscular ceftriaxone vs 5-day amoxicillin.
abstract: BACKGROUND
  Systemic antibiotics are routinely prescribed for severe acute malnutrition (SAM). However, there is no consensus regarding the most suitable regimen. In a therapeutic feeding centre in Khartoum, Sudan, a randomised, unblinded, superiority-controlled trial was conducted, comparing once daily intramuscular injection with ceftriaxone for 2 days with oral amoxicillin twice daily for 5 days in children aged 6-59 months with SAM.
  
  
  METHODS
  Commencing with the first measured weight gain (WG) following admission, the risk difference and 95% confidence interval (95% CI) for children with a WG > or = 10 g/kg/day were calculated over a 14-day period. The recovery rate and case fatality ratio (CFR) between the two groups were also calculated.
  
  
  RESULTS
  In an intention-to-treat analysis of 458 children, 53.5% (123/230) in the amoxicillin group and 55.7% (127/228, difference 2.2%, 95% CI -6.9-11.3) in the ceftriaxone group had a WG > or = 10 g/kg/day during a 14-day period. Recovery rate was 70% (161/230) in the amoxicillin group and 74.6% (170/228) in the ceftriaxone group (p=0.27). CFR was 3.9% (9/230) and 3.1% (7/228), respectively (p=0.67). Most deaths occurred within the 1st 2 weeks of admission.
  
  
  CONCLUSIONS
  In the absence of severe complications, either ceftriaxone or amoxicillin is appropriate for malnourished children. However, in ambulatory programmes, especially where there are large numbers of admissions, ceftriaxone should facilitate the work of medical personnel.
authors.affiliation: Epicentre, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Dubray
authors.forename: Salah A
authors.initials: SA
authors.lastname: Ibrahim
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelmutalib
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Guerin
authors.forename: François
authors.initials: F
authors.lastname: Dantoine
authors.forename: François
authors.initials: F
authors.lastname: Belanger
authors.forename: Dominique
authors.initials: D
authors.lastname: Legros
authors.forename: Loretxu
authors.initials: L
authors.lastname: Pinoges
authors.forename: Vincent
authors.initials: V
authors.lastname: Brown
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000658:Amoxicillin / Q000008:administration & dosage* / Q000627:therapeutic use; D000886:Anthropometry; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications* / Q000503:physiopathology; D007273:Injections, Intramuscular; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D000658:Amoxicillin