Abstract:
Background Severe acute malnutrition (SAM) affects nearly 20 million children
worldwide and is responsible for up to 1 million deaths per year in children under the age
of 5 years. Current WHO guidelines recommend oral amoxicillin for children with
uncomplicated malnutrition and parenteral benzylpenicillin and gentamicin for those
with complicated malnutrition. Because of cost pressures and increasing antimicrobial
resistance, the administration of empirical antibiotics for children with SAM has recently
been debated. Methods A systematic review of the current published literature was
undertaken to assess the efficacy, safety, cost-effectiveness and pharmacokinetics of
antimicrobial treatment of children with SAM in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses. Results The initial search
found 712 papers, eight of which met the inclusion criteria. Quality assessment of the
studies was performed as per the Grading of Recommendations Assessment,
Development and Evaluation guidelines. International guidelines and clinical data
registries were also reviewed which identified inconsistencies in current first- and
second-line therapies and dosing regimens. Conclusion Current evidence supports the
continued use of broad-spectrum oral amoxicillin for treating children with
uncomplicated SAM as outpatients. There is no strong evidence to justify changing the
current parenteral therapy guidelines for children admitted with complicated SAM,
although they should be clarified to harmonise the dosage regimen of amoxicillin for the
treatment of SAM to 40 mg/kg twice daily, and to continue parenteral antimicrobials
beyond 2 days if indicated by the clinical condition.