Antibiotics Help Fight Severe Malnutrition

A starving child is covered with flies at the pediatric malnutrition ward at the Lilongwe Central Hospital, Malawi. (file photo)

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Steve Baragona
January 31, 2013

Severely malnourished children are more likely to survive if they receive antibiotics in addition to therapeutic feeding, according to a new study. In the study published in the New England Journal of Medicine, a weeks worth of common antibiotics reduced the death rate among severely malnourished children by 35 percent or more. About 20 million children worldwide are severely malnourished, and malnutrition is a factor in the death of about 1 million every year. So the results are a big deal, says lead author Indi Trehan, a pediatrician at Washington University. If you can cut the death rate by 35 percent for any disease, thats a huge finding," said Trehan. "And if you can do it with a $3 antibiotic, thats an even bigger finding. And if you can do it with a $3 antibiotic and a disease that kills a million kids a year, 35 percent less deaths - thats why were having this conversation today. Malnutrition stunts a childs physical and mental development. It also affects their defense against diseases of all kinds, from pneumonia to malaria to measles. Trehan says that can be the difference between life and death.

You can easily go into a village in the middle of a measles outbreak and hand -pick which ones are going to die," he said. "You can tell whats going to happen based on how scrawny they are. Until a few years ago, those scrawny kids would have needed to be hospitalized to treat their malnutrition. And still, as many as half of them would die. But with advances in ready-to-use therapeutic foods like PlumpyNut, a nutrient-fortified paste of peanuts and milk powder, these kids can be sent home and 85 to 90 percent of them recover fully. Its a huge advance, Trehan says. But if 10 or 15 percent still dont recover, and if 5 or 10 percent die, in a disease that hits 20 million kids a year, that 5 or 10 percent is still an outrageously large number that we cant be happy with," said Trehan. The Washington University pediatrician and his colleagues wondered if they could cut the number of deaths by sending malnourished kids home with antibiotics as well as nutrient-fortified therapeutic food. Public health authorities have recommended antibiotic treatment for malnutrition for several years. But there has been no solid medical evidence for its benefits. And indiscriminate use of antibiotics carries a risk of side effects, including antibiotic resistance. Plus, theres the added cost. So Indi Trehans group in Malawi had not prescribed them before. But he says the new results quickly changed their minds. We were extremely shocked," he said. "I rem ember the night when we started looking at the data, and I had to call up the lead investigator, Mark Manary, and I said, Can you believe this? This is actually happening. We were suspecting that this might be the case. However, we did not have any pr oof," said Myrto Schaefer.

Pediatrician Myrto Schaefer, with the relief organization Doctors Without Borders, says the group has been giving antibiotics to malnourished children anyway. But this is the first study to provide solid evidence for the practice. However, what we dont know is whether the results of this study can be easily transferred to the areas where the majority of children with severe malnutrition live," said Schaefer. Schaefer says severe malnutrition is most serious in the Sahel region of Africa. But malnourished kids there do not show the same symptoms as those in Malawi, where this study was done. That suggests the underlying causes are different, and go beyond just the lack of food. In fact, Trehan is co-author on an accompanying study that suggests the types of microbes living in the Malawian childrens gastro-intestinal tracts may be contributing to their malnutrition. You could give them the right diet, but if the right bugs arent there to help liberate your zinc, or your vitamin A or your proteins, then youre not going to really absorb them and use them for growth. And youre going to get malnourished," he said. Trehan acknowledges it's not really clear why the antibiotics are having the effect they are. He says thats what he plans to spend the next several years studying.

Antibiotics Cuts Deaths Among Severely Malnourished Kids

By Nicole Ostrow - Jan 30, 2013 9:00 PM PT

Antibiotics added to nutritional therapy helped aid recovery and prevent deaths among severely malnourished children, findings that suggest 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 the study published in the New England Journal of Medicine. Those given the antibiotic cefdinir, sold as Omnicef by Abbott Laboratories (ABT), had a 40 percent better recovery rate and 45 percent reduced death rate. More than 20 million children worldwide each year 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 study author Indi Trehan. Childhood malnutrition remains the biggest, and unfortunately, most under-recognized, health problem in the world, said Trehan, a clinical fellow in the Department of Pediatrics atWashington University in St. Louis and 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. In terms of bang-for-buck, this is where we need to focus the most.

Malnutrition Deaths
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 the age of 5 worldwide, 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 therapythat costs about $50 per child over the course of the treatment. The study included 2,767 Malawi children ages 6 months to 4 years who had severe acute malnutrition. They were given amoxicillin, cefdinir or placebo for seven days in addition to nutritional therapy, which is a ready-to-use paste that doesnt need to be mixed with water. Trehan said its unclear how the antibiotics work to benefit these children. It could be that the childrens 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.

Worthwhile Investment
We hope that international aid organizations and local health authorities will be able to incorporate the use of these simple antibiotics, Trehan said. We recognize that this will require additional financial and logistical resources, but the dramatic decrease in the mortality rates seen in this study has convinced us that this investment will be worthwhile for the benefit it provides to child survival worldwide. Another possibility, he said, was maybe the children already had an infection that tipped them over the edge into severe malnutrition and the antibiotics treated that condition. Trehan said in other studies its been shown that the intestinal barriers of children who are malnourished are weak and porous so intestinal bacteria may be able move into the blood. Its 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.

Direct Link
There is also a particularly severe form of malnutrition, called kwashiorkor, which cant be cured with nutrition alone, and that scientists recently tied to a type of bacteria in the gut. That finding, also by Trehan and researchers from Washington University in St. Louis, was published in thejournal Science. Researchers in the study looked at 317 pairs of Malawian twins in the first three years of their life. Over the study, half of the twin pairs were well nourished while in others, one or both twins developed kwashiorkor. They then found that the gut bacteria in those with the malnutrition who were given nutritional therapy became more similar to that of well- nourished children during treatment. When therapy was ended, the bacteria reverted back. Children with kwashiorkor suffer swelling, liver damage, anorexia and skin ulcers.

New Evidence
To test the bacterial link to kwashiorkor, the researchers then put fecal bacteria from three twin pairs into mice that were germ free. The mice that had the bacteria from the twin with kwashiorkor and ate the

Malawian diet developed symptoms of malnutrition. That provided the evidence of the link between the gut bacteria and kwashiorkor. The gut mucosa is the battleground not surprisingly between infection and malnutrition since it is the target of all sorts of infections f rom the environment and it is the site of the most immune activation, Trehan said. But when it becomes so inflamed due to this immune activation, the enteropathy that develops puts the child at risk for malabsorption and further infections. It is this vicious cycle that we would like to continue to study. To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net

Antibiotics Help Children Fight Malnutrition: Study

AffirunisaKankudti First Posted: Jan 31, 2013 08:09 AM EST

(Photo : REUTERS/Mohamed Dahir)

A new study has found that treating malnourished children with antibiotics along with a peanut-based food is better than just the therapeutic food. The study was based on data from more than 2,500 children in Malawi, in sub-Saharan Africa, who were suffering from malnourishment. "The findings are remarkable. Based on previous research, we didn't think there would be much benefit from antibiotics. We did not at all expect to see a drop in the death rate - but there was, and it is significant," said Indi Trehan, M.D., lead author of the research. Like Us on Facebook

All the children in the study were given therapeutic peanut-based food along with a pill that was either a placebo or an antibiotic - either amoxicillin or cefdinir. The food was given for an average of 30 days, while the antibiotics were given for seven days. Study results showed that children who received antibiotics had a better chance of survival than children who got the placebo along with the food supplement. More than 80 percent of the malnourished children enrolled in the study recovered from malnourishment. Researchers found that rate of death dropped by as much as 44 percent in children who were on cefdinir, while the drop was about 36 percent in kids treated with amoxicillin, compared with children who were on placebo or dummy drugs. Antibiotics- a game changer Every hour of every day, about 300 children die due to malnutrition, says Save the Children. In America, at least 16 million kids aren't sure where the next meal will come from. Researchers say that adding antibiotics to food aimed at fighting malnutrition can be a real game changer. "The addition of antibiotics has a profound impact that we hope will change how these children are treated worldwide. This trial provided very solid, very objective, top-of-the-line scientific evidence to answer the question of whether antibiotics should be added to severely malnourished children's treatment regimen. The answer is yes. This is a gamechanger. This will save more lives," said Mark Manary, M.D., senior author of the study, according to a news release. The study was conducted by researchers from Washington University School of Medicine in St. Louis and is published in the New England Journal of Medicine.

Read more at http://www.counselheal.com/articles/3655/20130131/antibiotics-help-children-fight-malnutritionstudy.htm#xqAPAvx9i3rprLME.99

Thursday
Researchers Find That Antibiotics Could Save Lives of Tens of Thousands of Malnourished Children
on January 31, 2013

Scientists discover big benefits in providing antiobiotics, along with nutrition, when treating malnourished children. The conclusions came from the first major new findings in a decade about the causes and treatment of severe malnutrition in children, which contributes to more than a million deaths a year. Two studies in Malawi, led by scientists from Washington University in St. Louis, reveal that severe malnutrition often involves more than a lack of food. The researchers found significant benefits from giving a weeks course of antibiotics to malnourished children who also were getting a peanut butter-based nutritional supplement. For every million children treated, more than 20,000 lives might be saved. The New York Times

Health Buzz: Antibiotics Help Malnourished Children in Malawi

By LAURA MCMULLEN
January 31, 2013 RSS Feed Print

Antibiotics, in Addition to Food, May Be a Lifesaver for Starving Children

More than 20 million children worldwide suffer from severe malnutrition, and annually, more than 1 million children die from it. A new study sheds light on how they can be helped. The study took place in the Republic of Malawi, in southeast Africa, where researchers discovered that serving food alone only went so far with these kids. Malnourished children are also prone to illness, reports The New York Times, and so giving them antibiotics in addition to nutritional treatment led to a vast improvement in their recovery and mortality rates. "By a week or two of treatment you see these kids gaining incredible amounts of weight," Indi Trehan, study author and clinical fellow at the Washington University in St. Louis Institute for Public Health, told The New York Times. The study of more than 2,500 children was published yesterday in The New England Journal of Medicine.