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.     

Clinical predictors and outcome of hypoxaemia among under-five diarrhoeal children with or without pneumonia in an urban hospital, Dhaka, Bangladesh

Objective To explore the predictors and outcome of hypoxaemia in children under 5 years of age who were hospitalized for the management of diarrhoea in Dhaka, where comorbidities are common. Methods In a prospective cohort study, we enrolled all children <5 years of age admitted to the special care ward (SCW) of the Dhaka Hospital of ICDDR,B from September to December 2007. Those who presented with hypoxaemia (SpO₂ < 90%) constituted the study group, and those without hypoxaemia formed the comparison group. Results A total of 258 children were enrolled, all had diarrhoea. Of the total, 198 (77%) had pneumonia and 106 (41%) had severe malnutrition (Z‐score of weight for age of the median of the National Centre for Health Statistics), 119 (46%) had hypoxaemia and 138 children did not have hypoxaemia at the time of admission. Children with hypoxaemia had a higher probability of a fatal outcome (21%vs. 4%; P < 0.001). Using logistic regression analysis, the independent predictors of hypoxaemia at the time of presentation were lower chest wall indrawing [OR 6.91, 95% confidence intervals (CI) 3.66–13.08, P < 0.001], nasal flaring (OR 3.22, 95% CI 1.45–7.17, P = 0.004) and severe sepsis (OR 4.48, 95% CI 1.62–12.42, P = 0.004). Conclusion In this seriously ill population of children with diarrhoea and comorbidities, hypoxaemia was associated with high case–fatality rates. Independent clinical predictors of hypoxaemia in this population, identifiable at the time of admission, were lower chest wall indrawing, nasal flaring and the clinical syndrome of severe sepsis.