title: The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science.
  
  
  METHODS
  Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention.
  
  
  RESULTS
  Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. In random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions.
  
  
  CONCLUSIONS
  Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. The antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Ethan K
authors.initials: EK
authors.lastname: Gough
authors.forename: Erica E M
authors.initials: EE
authors.lastname: Moodie
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Prendergast
authors.forename: Sarasa M A
authors.initials: SM
authors.lastname: Johnson
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
authors.forename: A Sarah
authors.initials: AS
authors.lastname: Walker
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
authors.forename: Rie
authors.initials: R
authors.lastname: Goto
authors.forename: Soraia
authors.initials: S
authors.lastname: Tahan
authors.forename: Mauro Batista
authors.initials: MB
authors.lastname: de Morais
authors.forename: Amee R
authors.initials: AR
authors.lastname: Manges
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data*; D006133:Growth Substances / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D006133:Growth Substances
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