New Delhi: The routine use of antibiotics in the treatment of severe acute malnutrition (SAM) does not have any impact on recovery of affected children, shows a study published in latest issue of The New England Journal of Medicine. The findings challenge the position held by the World Health Organisation that SAM children should receive antibiotics. SAM is the worst form of malnutrition.

The study was conducted on 2399 children in Madarounfa, Niger from October 2012 to November 2013 by international non-profit Médecins Sans Frontières (MSF) and its research arm Epicentre.

For the study, which was conducted on SAM children without complications that require hospitalisation, the researchers assigned children six to 59 months of age to receive either amoxicillin antibiotics or placebo for seven days. Nutritional recovery occurred in 65.9% of children in the group that received amoxicillin and in 62.7% of the children in the placebo group.

“There was no significant difference in likelihood of nutritional recovery with amoxicillin versus placebo," said Myrto Schaefer, MSFdeputy medical director. “This finding challenges the prevailing view that routine antibiotic therapy to treat malnutrition is always necessary or beneficial."

The current guidelines of the WHO recommend that children with severe acute malnutrition who do not have health complications that require hospitalisation, should “receive special, high-energy food and antibiotics to treat infection."

In 1999, when all children with severe acute malnutrition were treated as inpatients, the WHO recommended routine use of broad-spectrum antibiotics for the management of severe acute malnutrition. In recent years, the WHO and United Nations have endorsed a community-based model for the management of malnutrition, in which children with uncomplicated severe acute malnutrition are treated at home with ready-to-use therapeutic food, and broad use of antibiotics is still recommended.

Apart from not benefitting the children, antibiotic use contributes to development of antibiotic resistance which can make even simple diseases costly to treat. In Niger, routine use of antibiotics for the treatment of SAM accounts for 15% of all antibiotic use among children younger than five.

“Given the cost and public health consequences of emerging antibiotic resistance associated with routine antibiotic use, current practices in the treatment of malnutrition should be questioned and studied further," said Rebecca Grais, director of research at Epicentre.

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