Monday, 31 March 2014

The Use of Antibiotics in severe acute malnourished peadiatric patients

Antimicrobial use in complicated and uncomplicated cases of severe acute malnourishment (SAM) in the paediatric population


Public Health Care Facilities with paediatric patients from low-income households with poor socioeconomic circumstances - looking at complicated and uncomplicated SAM cases.


Description of drug therapy problem
You have a SAM patient with no signs or symptoms of infection e.g. fever. The white cell count (WCC) and C-reactive protein (CRP) are not elevated. It was thus decided that there was no obvious symptoms showing that there was an infection. Do they still require a course of antibiotics?


Here is some food for thought: Many children with SAM have infections which are said to be ‘silent’ with no apparent symptoms. The use of antibiotics in this population group has been supported by the World Health Organisation (WHO).in both in-patient and out-patient settings.


The rationale for the use of a course of antibiotics in this population is that there has been found to be a high incidence of pneumonia, bacteraemia, gastroenteritis and urinary tract infections (UTIs) amoung them. Both gram-positive as well as gram-negative organisms have been isolated. This supports the use of broad spectrum antimicrobials. The choice of antibiotic may differ according to your institutions sensitivity patterns.


Below are references to some articles which may shed some light on the subject. Please share your views,




  1. Dr I Smuts, Prof I Venter, Dr S Brown, Dr S King, Dr ED Nel, Prof D Marais et al. Standard Treatment Guidelines and Essential Medicines List for South Africa: Hospital Level Paediatrics. 2006 Edition. Chapter 2: Acute diarrhoea pg. 23-33.


  1. WJ Klish, BL Nicholis. Severe malnutrition in children in developing countries: Treatment. [Updated 28 February 2014]. Available from


  1. M Lazzerini, D Tickell. Antibiotics in severely malnourished children; systemic review of efficacy, safety and pharmacokinetics. Bulletin of the WHO 2011; 89: 594-607


  1. I Trehan, HS Goldbach, LN LaGrone, GJ Meuli, RJ Wang, KM Maleta et al. Antibiotics as part of the Management of Severe Acute Malnutrition. NEJM 31 January 2013; 425-435.


  1. G Alcoba, M Kerac, S Breysse, C Salpeteur, A Galetto-Lacour, A Briend et al. Do children with uncomplicated severe acute malnutrition need antibiotics? A systematic review and meta-analysis. Available at 


  1. A Page, N de Rekeneire, S Sayadi, S Aberrane, AC Janssens, A Djibo et al. Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger. 17 July 2013: (8)7; 1-9. Available at 


  1. HR Shashidhar. Malnutrition. [Updated 11 February 2013]. Available from 

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