title: Antibiotics as part of the management of severe acute malnutrition.
abstract: Severe acute malnutrition contributes to 1 million deaths among children annually. Adding routine antibiotic agents to nutritional therapy may increase recovery rates and decrease mortality among children with severe acute malnutrition treated in the community.
  
  
  
  In this randomized, double-blind, placebo-controlled trial, we randomly assigned Malawian children, 6 to 59 months of age, with severe acute malnutrition to receive amoxicillin, cefdinir, or placebo for 7 days in addition to ready-to-use therapeutic food for the outpatient treatment of uncomplicated severe acute malnutrition. The primary outcomes were the rate of nutritional recovery and the mortality rate.
  
  
  
  A total of 2767 children with severe acute malnutrition were enrolled. In the amoxicillin, cefdinir, and placebo groups, 88.7%, 90.9%, and 85.1% of the children recovered, respectively (relative risk of treatment failure with placebo vs. amoxicillin, 1.32; 95% confidence interval [CI], 1.04 to 1.68; relative risk with placebo vs. cefdinir, 1.64; 95% CI, 1.27 to 2.11). The mortality rates for the three groups were 4.8%, 4.1%, and 7.4%, respectively (relative risk of death with placebo vs. amoxicillin, 1.55; 95% CI, 1.07 to 2.24; relative risk with placebo vs. cefdinir, 1.80; 95% CI, 1.22 to 2.64). Among children who recovered, the rate of weight gain was increased among those who received antibiotics. No interaction between type of severe acute malnutrition and intervention group was observed for either the rate of nutritional recovery or the mortality rate.
  
  
  
  The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates. (Funded by the Hickey Family Foundation and others; ClinicalTrials.gov number, NCT01000298.).
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A.; Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Hayley S
authors.initials: HS
authors.lastname: Goldbach
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: Lacey N
authors.initials: LN
authors.lastname: LaGrone
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A.
authors.forename: Guthrie J
authors.initials: GJ
authors.lastname: Meuli
authors.affiliation: Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, U.S.A.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wang
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Maleta
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A.; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; U.S. Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, U.S.A.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary