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Routine antibiotics in SAM children

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Neha

Normal user

4 Apr 2017, 10:30

Dear all,
As per protocol we have to administer routine antibiotics (amox) for all SAM children including those without apparent signs of infection. I would like to know feasibility of using cephalosporins (1st generation cefalexin) over amoxicillin. It is an ongoing discussion within our medical team to use cefalexin, however we are not finding any reference stating use of other antibiotics and dosage of the same in SAM children. I would appreciate if someone can help us with any reference material for drugs in SAM children.

Paul

Technical expert

4 Apr 2017, 13:31

Try these,

http://www.actionagainsthunger.org/sites/default/files/publications/Guidelines_For_the_integrated_management_of_severe_acute_malnutrition_In_and_out_patient_treatment_12.2011.pdf

https://www.researchgate.net/publication/292131715_Golden_MH_Grellety_Y_Integrated_Management_of_Acute_Malnutrition_IMAM_Generic_Protocol_ENGLISH_version_662

Paul

Dr Charulatha Banerjee

Asia Regional Knowledge Management Specialist

Normal user

4 Apr 2017, 13:36

Dear Neha,

The WHO 2013 guidelines update on management of SAM has a detailed section on antibiotics. It does mention a trial where use of oral cephalosporin 3rd generation (not cephalexin) seems as effective as amoxicillin itself. I think the point the trial was making was actually that amoxicillin is good enough.

I have not come across any other trial of antibiotics for SAM children.

I am also curious to understand Why your team considering a change of antibiotic?

Hope this helps

Neha

Normal user

5 Apr 2017, 04:58

Dear Charulatha ,

We do not want to replace amox however there are certain queries raised by visiting medical fraternity about treatment with amox. we want to justify use of amox with strong medical evidences. Also prevalence of diarrhea is extremely high in the community and they feel in this context using amox will not be effective.

Issack

Normal user

5 Apr 2017, 08:09

Most severely malnourished children have several infections, but they cannot be diagnosed due to diminished inflammatory response (which hides the signs of infection). Treat all children admitted to the OTP. First line choice is Amoxicillin for 7 days, as it is effective against small bowel overgrowth, usually associated with malnutrition. Some epidemiological studies have documented a high prevalence of pneumonia, bacteraemia and urinary tract infections in children with malnutrition. In this cohort a wide range of both Gram-positive and Gram-negative organisms are frequently isolated, which supports the recommendation of a broad spectrum antibiotic for these children.
Please see also this link-Somali national guideline developed by INGO, LNGO and UN agencies i.e WHO, UNICEF and WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children.
World Health Organization; 2013 http://www.mohpuntland.com/wp content/uploads/2016/03/Guideline-for-Integrated-management-of-Acute-Malnutrition.

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