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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antibiotics as part of the management of severe acute malnutrition

Indi Trehan1, Hayley S Goldbach, Lacey N LaGrone

  • 1Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA.

The New England Journal of Medicine
|February 1, 2013
PubMed

Insights

Adding antibiotics like amoxicillin or cefdinir to standard treatment significantly improved recovery and reduced mortality in children with severe acute malnutrition. This finding offers a crucial strategy for combating childhood malnutrition globally.

Area of Science:

  • Pediatric Infectious Diseases
  • Global Child Health
  • Nutritional Science

Background:

  • Severe acute malnutrition (SAM) is a leading cause of child mortality, responsible for approximately 1 million deaths annually.
  • Routine antibiotic administration alongside nutritional therapy may enhance recovery and reduce mortality in SAM cases treated on an outpatient basis.

Purpose of the Study:

  • To evaluate the efficacy of amoxicillin and cefdinir, in addition to therapeutic food, on nutritional recovery and mortality rates in children with severe acute malnutrition.
  • To compare the outcomes of amoxicillin and cefdinir treatment against a placebo in the outpatient management of uncomplicated SAM.

Main Methods:

  • A randomized, double-blind, placebo-controlled trial was conducted involving 2767 Malawian children aged 6 to 59 months with SAM.
  • Participants received ready-to-use therapeutic food plus either amoxicillin, cefdinir, or a placebo for 7 days.

Main Results:

  • Nutritional recovery rates were 88.7% for amoxicillin, 90.9% for cefdinir, and 85.1% for placebo.
  • Mortality rates were 4.8% (amoxicillin), 4.1% (cefdinir), and 7.4% (placebo), with antibiotics showing significant risk reduction.
  • Children receiving antibiotics exhibited increased weight gain post-recovery.

Conclusions:

  • The addition of antibiotics to nutritional therapy significantly improved recovery rates and reduced mortality in children with uncomplicated severe acute malnutrition.
  • Antibiotic treatment represents a valuable adjunct to standard therapeutic regimens for SAM, potentially saving lives and improving outcomes.
Abstract

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