NEW YORK -- Antibiotics added to nutritional therapy helped aid recovery and prevent deaths among severely malnourished children, findings which suggest that routine use of the drugs should be considered in kids who suffer from acute hunger.
Children with severe malnutrition who were given amoxicillin had a 25 percent greater recovery rate and a 35 percent lower death rate than those who took a placebo, according to a study published Wednesday in the New England Journal of Medicine. Those given the antibiotic cefdinir, sold as Omnicef by Abbott Laboratories, had a 40 percent better recovery rate and 45 percent reduced death rate.
More than 20 million children worldwide annually suffer from severe acute malnutrition, leading to 1 million deaths each year. While the recovery rate is between 85 percent and 90 percent, adding antibiotics may offer a cost-effective approach to improve health and survival, said the study's author, Indi Trehan, a clinical fellow in Washington University's Department of Pediatrics in St. Louis.
"Childhood malnutrition remains the biggest -- and, unfortunately, most under-recognized -- health problem in the world," said Dr. Trehan, also a visiting lecturer at the University of Malawi, in a Jan. 26 e-mail. "In the end, no matter what advances we make in HIV or malaria or diarrhea, malnourished children will always be at the highest risk of death from these diseases."
Malnutrition, defined by the World Health Organization as a very low weight-for-height and severe wasting, accounts for almost half of all child deaths under age 5 worldwide, Dr. Trehan said.
Amoxicillin cost about $2.67 per child in the study, while the cefdinir was $7.85. That expense can be lower if used on a large scale, the authors said. That compares with nutritional therapy that costs about $50 per child over the treatment course.
The study included 2,767 Malawi children ages 6 months to 4 years who had severe acute malnutrition.
They were given amoxicillin, cefdinir or a placebo for seven days in addition to nutritional therapy, which is a ready-to-use paste that doesn't need to be mixed with water.
Dr. Trehan said it is unclear how the antibiotics work to benefit these children. It could be that the children's immune systems were so compromised by the malnutrition that they were unable to clear any simple infections on their own. By providing them the antibiotics early on, they may have been protected from typical childhood infections that came along during the study.
"We hope that international aid organizations and local health authorities will be able to incorporate the use of these simple antibiotics," Dr. Trehan said.
Another possibility, he said, was the children perhaps already had an infection that "tipped them over the edge" into severe malnutrition, and the antibiotics treated that condition.
Dr. Trehan said it has been shown in other studies that the intestinal barriers of children who are malnourished are weak and porous, so intestinal bacteria may be able move into the blood.
It is possible that the antibiotics might be helpful in limiting the amount of infection and inflammation in the gut, helping them to maximize absorption of the nutritional therapy.