Evaluation of the routine use of amoxicillin as part of the home‐based treatment of severe acute malnutrition

Objective To determine whether the inclusion of amoxicillin correlates with better recovery rates in the home‐based treatment of severe acute malnutrition with ready‐to‐use therapeutic food. Methods This retrospective cohort study compared data from the treatment of two groups of children in Malawi aged 6–59 months with uncomplicated severe acute malnutrition. The standard protocol group received a 7‐day course of amoxicillin at the onset of treatment. The alternate protocol group received no antibiotics. All children were treated with the same ready‐to‐use therapeutic food. The primary outcome was nutritional recovery, defined as achieving a weight‐for‐height Z‐score > ?2 without oedema. Results Four hundred and ninety‐eight children were treated according to the standard protocol with amoxicillin, and 1955 were treated under the alternate protocol without antibiotics. The group of children treated with amoxicillin was slightly older and more stunted at baseline. The recovery rate for children who received amoxicillin was worse at 4 weeks (40%vs. 71%) but similar after up to 12 weeks of therapy (84%vs. 86%), compared to the children treated without antibiotics. Regression modelling indicated that this difference at 4 weeks was most strongly associated with the receipt of amoxicillin. Conclusions This review of two therapeutic feeding programmes suggests that children with severe acute malnutrition who were treated without amoxicillin did not have an inferior rate of recovery. Given the limitations of this retrospective analysis, a prospective trial is warranted to determine the effect of antibiotics on recovery from uncomplicated malnutrition with home‐based therapy.