Research Highlights: Inclusion of Antibiotics in Nutritional Therapy for Children Afflicted with Acute Malnutrition Associated with Improved Recovery and Decreased Mortality Rates

Inclusion of Antibiotics in Nutritional Therapy for Children Afflicted with Acute Malnutrition Associated with Improved Recovery and Decreased Mortality Rates

By: Joseph St. Pierre

The New England Journal of Medicine recently published an article detailing the association of antibiotic regimen implementation in nutritional therapies for malnourished children of 6 to 59 years of age with improved recovery time, weight gain, and reduced mortality rates. In the study described, Pediatric researchers found that acutely malnourished children whose nutritional therapies were supplemented with a regimen of either of the antibiotics amoxicillin or cefdinir experienced significantly lower rates of treatment failure, as well as significantly lower mortality rates, over children whose nutritional therapies were supplemented with only a placebo.

The study saw the participation of 2767 malnourished children spread across 18 feeding centers throughout Malawi. Children taking part in the study were stated to possess similiar baseline characteristics and were subject to outpatient care. Participants were randomly assigned to one of three groups, each of which were supplemented the usual routine of counseling and a daily dose of RUTF (Ready-to-Use Therapeutic Food) with either amoxicillin, the cefdinir, or a placebo during the first seven days of therapy. Over the course of the study, recovery rate, mortality rates, and weight and length gain were documented and compared amongst groups via stastical analysis. Children receiving the placebo suffered significantly higher occurances of treatment failure and death. Furthermore, the groups receiving amoxicillin or cefdinir experienced significantly shorter recovery times than those observed in the placebo group, with the amoxicillin group exhibiting the stastically shortest recovery times of the three.

Researchers admit that there are factors that may limit the applicability of the data collected. For example, the study was performed in Malawi, where HIV is a prevalent affliction. Only 31.6% of the study's participants were tested for HIV, and those confirmed to have disease were described to be at most risk for treatment failure. Furthermore, factors like age also had a significant effect on treatment outcome, with younger participants exhibiting increased rates of treatment failure. However, the data does support the possibility that even when subject to nutritional therapy, malnourished children possess increased vulnerability to bacterial infection, and that more research should be performed to assess whether supplementing RUTF nutritional therapy with an antibiotic regimen could be of significant benefit to high-risk populations.

NEJM. 2013. 368: 425-435.

Joseph St. Pierre is an affiliated staff writer for Tuftscope (2012-2013)