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Amoxicillin for critically ill children with enteral nutrition intolerance (AmoxENI study): A randomized controlled

Rania G Abdelatif1, Abanob A Francis1, Elsayed Abdelkreem1

  • 1Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt.

Journal of Pediatric Gastroenterology and Nutrition
|June 12, 2025
PubMed

Insights

Amoxicillin significantly improved enteral nutrition intolerance in critically ill children. This treatment led to better nutritional intake and fewer gastrointestinal symptoms, suggesting a potential therapeutic role.

Area of Science:

  • Pediatric critical care medicine
  • Clinical pharmacology
  • Gastroenterology

Background:

  • Enteral nutrition intolerance (ENI) is a common challenge in pediatric intensive care units (PICUs).
  • Effective management of ENI is crucial for improving patient outcomes.
  • ClinicalTrials.gov identifier: NCT05828758.

Purpose of the Study:

  • To evaluate the efficacy of amoxicillin in treating ENI in children admitted to the PICU.
  • To assess the impact of amoxicillin on nutritional intake and gastrointestinal symptoms.

Main Methods:

  • A randomized controlled trial involving 90 children (1 month to 12 years) with ENI.
  • Participants received either amoxicillin (10 mg/kg) or placebo via gastric tube three times daily for one week.
  • Primary outcome: achieving ≥2/3 energy requirement without significant GI symptoms on Day 7 post-treatment.

Main Results:

  • Amoxicillin group achieved the primary outcome in 75.6% vs. 31.1% in placebo (RR: 2.4, p<0.001).
  • Amoxicillin significantly increased enteral nutrition intake (60% vs. 24%, p<0.001) and reduced vomiting and diarrhea.
  • No significant differences were observed in other secondary outcomes between groups.

Conclusions:

  • Amoxicillin shows promise in improving ENI in critically ill children.
  • Further research is needed to confirm findings, explore mechanisms, and assess clinical utility.
Abstract

Keywords:
beta‐lactamsdelayed gastric emptyingfeeding intolerancepediatric intensive care unitprokinetic

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