Treatment of severe malnutrition with 2-day intramuscular ceftriaxone vs 5-day amoxicillin
Treatment of severe malnutrition with 2-day intramuscular ceftriaxone vs 5-day amoxicillin
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DOI：
10.1179/146532808x270635
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发表时间：
2008-03-01
影响因子：
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通讯作者：
Brown, Vincent
中科院分区：
文献类型：
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作者：
Dubray, Christine;Ibrahim, Salah A.;Brown, Vincent
背景全身抗生素是严重急性营养不良（SAM）的常规处方。然而，关于最合适的方案没有达成共识。在苏丹喀土穆的一个治疗性喂养中心，进行了一项随机、非盲、优势对照试验，比较6-59个月SAM患儿每日一次肌内注射头孢曲松2天与每日两次口服阿莫西林5天的疗效。从入院后第一次测量体重增加（WG）开始，计算14天内WG >= 10 g/kg/d儿童的风险差异和95%置信区间（95% CI）。比较两组的治愈率和病死率。在对458名儿童进行的意向治疗分析中，阿莫西林组53.5%（123/230）和头孢曲松组55.7%（127/228，差异2.2%，95%CI-6.9-11.3）在14天内WG >= 10 g/kg/d。阿莫西林组的回收率为70%（161/230），头孢曲松组为74.6%（170/228）（p=0.27）。CFR分别为3.9%（9/230）和3.1%（7/228）（p=0.67）。大多数死亡发生在入院后的前2周内。结论。在没有严重并发症的情况下，头孢曲松或阿莫西林都适用于营养不良的儿童。然而，在门诊方案中，特别是在有大量入院的情况下，头孢曲松应有助于医务人员的工作。
Background. Systemic antibiotics are routinely prescribed for severe acute malnutrition (SAM). However, there is no consensus regarding the most suitable regimen. In a therapeutic feeding centre in Khartoum, Sudan, a randomised, unblinded, superiority-controlled trial was conducted, comparing once daily intramuscular injection with ceftriaxone for 2 days with oral amoxicillin twice daily for 5 days in children aged 6-59 months with SAM.Methods. Commencing with the first measured weight gain (WG) following admission, the risk difference and 95% confidence interval (95% CI) for children with a WG >= 10 g/kg/day were calculated over a 14-day period. The recovery rate and case fatality ratio (CFR) between the two groups were also calculated.Results. In an intention-to-treat analysis of 458 children, 53.5% (123/230) in the amoxicillin group and 55.7% (127/228, difference 2.2%, 95% CI -6.9-11.3) in the ceftriaxone group had a WG >= 10 g/kg/day during a 14-day period. Recovery rate was 70% (161/230) in the amoxicillin group and 74.6% (170/228) in the ceftriaxone group (p=0.27). CFR was 3.9% (9/230) and 3.1% (7/228), respectively (p=0.67). Most deaths occurred within the 1st 2 weeks of admission.Conclusion. In the absence of severe complications, either ceftriaxone or amoxicillin is appropriate for malnourished children. However, in ambulatory programmes, especially where there are large numbers of admissions, ceftriaxone should facilitate the work of medical personnel.