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Routine antibiotics in community management of SAM

This question was posted the Management of wasting/acute malnutrition forum area and has 1 replies.

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Spencer Rivadeneira Danies


Normal user

29 May 2019, 19:14

Buenas tardes. ¿Además de los estudios de Niger y Malawi, respecto al uso rutinario de antibióticos en el manejo de la desnutrición aguda severa, sin complicaciones, en comunidad; existe nueva evidencia científica?

Google translate:

Good afternoon. In addition to the studies of Niger and Malawi, regarding the routine use of antibiotics in the management of severe acute malnutrition, without complications, in the community; Is there any new scientific evidence? Thank you


Action Against Hunger UK

Technical expert

18 Jun 2019, 11:38

The abstract from a systematic review from 2018 is provided below:


Background: Severe acute malnutrition (SAM) affects nearly 20 million children worldwide and is responsible for up to 1 million deaths per year in children under the age of 5 years. Current WHO guidelines recommend oral amoxicillin for children with uncomplicated malnutrition and parenteral benzylpenicillin and gentamicin for those with complicated malnutrition. Because of cost pressures and increasing antimicrobial resistance, the administration of empirical antibiotics for children with SAM has recently been debated.

Methods: A systematic review of the current published literature was undertaken to assess the efficacy, safety, cost-effectiveness and pharmacokinetics of antimicrobial treatment of children with SAM in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses.

Results: The initial search found 712 papers, eight of which met the inclusion criteria. Quality assessment of the studies was performed as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. International guidelines and clinical data registries were also reviewed which identified inconsistencies in current first- and second-line therapies and dosing regimens.

Conclusion: Current evidence supports the continued use of broad-spectrum oral amoxicillin for treating children with uncomplicated SAM as outpatients. There is no strong evidence to justify changing the current parenteral therapy guidelines for children admitted with complicated SAM, although they should be clarified to harmonise the dosage regimen of amoxicillin for the treatment of SAM to 40 mg/kg twice daily, and to continue parenteral antimicrobials beyond 2 days if indicated by the clinical condition.

Williams, P., & Berkley, J. A. (2018). Guidelines for the treatment of severe acute malnutrition: a systematic review of the evidence for antimicrobial therapy. Paediatrics and international child health38(sup1), S32–S49. doi:10.1080/20469047.2017.1409453




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