Treatment of severe malnutrition with 2-day intramuscular ceftriaxone vs 5-day amoxicillin.
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.
Dubray
Christine
C
Epicentre, Paris, France.
Ibrahim
Salah A
SA
Abdelmutalib
Mohamed
M
Guerin
Philippe J
PJ
Dantoine
François
F
Belanger
François
F
Legros
Dominique
D
Pinoges
Loretxu
L
Brown
Vincent
V
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
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D000658:Amoxicillin