Title:
Individual and Public Health Risks and Benefits of the Routine Use of Amoxicillin in the Treatment of Severe Acute Malnutrition (Sam) in Ambulatory Settings in Sub Saharan Africa
Authors:
Rijnierse, Erna
Place:
Amsterdam, The Netherlands
Publisher:
KIT - Royal Tropical Institute [etc.]
Year:
2022
PAGE:
49
Language:
En
Subject:
Health and Poverty
Keywords:
Severe acute malnutrition, antibiotics, antimicrobial resistance, determinants
Abstract:
BACKGROUND: About 47 million children under five worldwide are acutely malnourished; 14.3 million of them suffer from severe acute malnutrition (SAM). So far, all children with uncomplicated SAM routinely receive a course of antibiotics when starting treatment. Evidence supporting routine antibiotic use at admission to a nutritional ambulatory treatment programme remains limited. Many studies show that any unnecessary use of antibiotics is a risk for antimicrobial resistance. This thesis studies the pros and cons for the systematic use of antibiotics in children with uncomplicated SAM in ambulatory feeding programmes in Sub Saharan Africa in the light of the emerging antimicrobial resistance. METHODS: This thesis encompasses a literature review, expert consultation and reviews of the systematic use of antibiotics in the treatment of SAM from different angles and from various perspectives: caregivers, health workers and health systems. The literature review is done using the Vrije Universiteit library, PubMed on relevant trials on antibiotics and SAM, contextual information on the areas of those trials, factors that lead to antimicrobial resistance. Data were searched in period from 2010 till now. In addition, websites from WHO and NGOs were searched for relevant data and documents. The data are triangulated with expert interviews from the field of malnutrition and antimicrobial resistance. The framework used is based on the Antibiotics Smart Use model and includes social determinants of health, which could potentially play a role in the development of antimicrobial resistance. RESULTS: Two out of six single studies showed no significant difference in recovery rates. However, in one trial there was a difference in referral rates: more referrals in group without antibiotics. The quality of the other study showing no difference was low. Four studies (one RCT and 4 retrospective studies) showed a better outcome with antibiotics. A meta-analysis found a small big significant difference in favour of using amoxicillin: combined RR 1.03, 95% CI [1.00–1.06], p = 0.03). Reliable data on antimicrobial resistance (AMR) are often not available in the contexts where malnutrition rates are high. Acquisition of AMR is described in hospital settings only so far, no information on acquisition of AMR in ambulatory feeding programs has been published. Acquisition of AMR bacteria in the group of children with severe acute malnutrition that received amoxicillin was significantly higher (53.7% versus 32.2%, adjusted RR = 2.29, P = 0.001) than in the placebo group. Moreover, the same goes for their siblings, who did not take antibiotics. Risk factors for antimicrobial resistance are overuse of antibiotics, not properly using them and poor infection prevention and control. All but one expert believe systematic antibiotics should be continued. While all experts agreed that many children do probably not need antibiotics, there is currently no way on how to detect and decide who does not need them. CONCLUSION: Based on the current context in sub–Saharan Africa and the current evidence, systematic antibiotics are needed for SAM children in ambulatory settings, despite potential risk on increased AMR. Not using antibiotics may increase the risk of hospital admission, resulting in an increased risk of AMR as well, on top of an increased risk of a poor outcome of the child’s health.
Organization:
KIT - Royal Tropical Institute , VU - Vrije Universiteit Amsterdam
Institute:
KIT (Royal Tropical Institute)
Country:
Sub Saharan Africa
Region:
Central Africa, East Africa, Southern Africa, and West Africa
Training:
Master of Science in International Health
Category:
Research
Right:
@ 2022 Rijnierse
Document type:
Thesis/dissertation
File:
JUTmwaJW5h_20230509154750369.pdf