title: Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children.
abstract: BACKGROUND
  High-quality evidence supporting a community-based treatment protocol for children with severe acute malnutrition, including routine antibiotic use at admission to a nutritional treatment program, remains limited. In view of the costs and consequences of emerging resistance associated with routine antibiotic use, more evidence is required to support this practice.
  
  
  METHODS
  In a double-blind, placebo-controlled trial in Niger, we randomly assigned children who were 6 to 59 months of age and had uncomplicated severe acute malnutrition to receive amoxicillin or placebo for 7 days. The primary outcome was nutritional recovery at or before week 8.
  
  
  RESULTS
  A total of 2412 children underwent randomization, and 2399 children were included in the analysis. Nutritional recovery occurred in 65.9% of children in the amoxicillin group (790 of 1199) and in 62.7% of children in the placebo group (752 of 1200). There was no significant difference in the likelihood of nutritional recovery (risk ratio for amoxicillin vs. placebo, 1.05; 95% confidence interval [CI], 0.99 to 1.12; P=0.10). In secondary analyses, amoxicillin decreased the risk of transfer to inpatient care by 14% (26.4% in the amoxicillin group vs. 30.7% in the placebo group; risk ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02).
  
  
  CONCLUSIONS
  We found no benefit of routine antibiotic use with respect to nutritional recovery from uncomplicated severe acute malnutrition in Niger. In regions with adequate infrastructure for surveillance and management of complications, health care facilities could consider eliminating the routine use of antibiotics in protocols for the treatment of uncomplicated severe acute malnutrition. (Funded by Médecins sans Frontières Operational Center Paris; ClinicalTrials.gov number, NCT01613547.).
authors: From the Department of Research, Epicentre (S.I., C.L., F.B., S.G., R.F.G.), and Médecins sans Frontières Operational Center Paris (M.S.), Paris; the Departments of Nutrition (S.I.) and Global Health and Population (S.I., N.L.), Harvard T.H. Chan School of Public Health, Boston; and the Ministry of Health (N.O.), Forum Santé Niger (S.H.), and National Hospital (E.A.), Niamey, and UNICEF, Maradi (H.H.) - all in Niger.
authors: Sheila
authors: S
authors: Isanaka
authors: Céline
authors: C
authors: Langendorf
authors: Fatou
authors: F
authors: Berthé
authors: Smaila
authors: S
authors: Gnegne
authors: Nan
authors: N
authors: Li
authors: Nassirou
authors: N
authors: Ousmane
authors: Souley
authors: S
authors: Harouna
authors: Hamidine
authors: H
authors: Hassane
authors: Myrto
authors: M
authors: Schaefer
authors: Eric
authors: E
authors: Adehossi
authors: Rebecca F
authors: RF
authors: Grais
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D000067011:Severe Acute Malnutrition / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017211:Treatment Failure; D015430:Weight Gain / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin