Antibiotics as part of the management of severe acute malnutrition.
Antibiotics as part of the management of severe acute malnutrition.
复制标题
DOI：
10.1056/nejmoa1202851
复制
发表时间：
2013-01-31
期刊：
影响因子：
--
通讯作者：
Manary MJ
中科院分区：
文献类型：
--
作者：
Trehan I;Goldbach HS;LaGrone LN;Meuli GJ;Wang RJ;Maleta KM;Manary MJ
严重急性营养不良每年造成100万儿童死亡。在营养治疗中添加常规抗生素可能会提高社区治疗的严重急性营养不良儿童的康复率并降低死亡率。在这项随机、双盲、安慰剂对照试验中，我们将6至59个月的马拉维儿童随机分配为严重急性营养不良，接受阿莫西林、头孢地尼或安慰剂治疗7天，此外还接受即食治疗食品，用于门诊治疗无并发症的严重急性营养不良。主要结果是营养恢复率和死亡率。共有2767名患有严重急性营养不良的儿童参加了研究。在阿莫西林、头孢地尼和安慰剂组中，分别有88.7%、90.9%和85.1%的儿童痊愈（安慰剂组与阿莫西林组治疗失败的相对风险为1.32; 95%置信区间[CI]为1.04 - 1.68;安慰剂组与头孢地尼组的相对风险为1.64; 95% CI为1.27 - 2.11）。三组的死亡率分别为4.8%、4.1%和7.4%（安慰剂组与阿莫西林组的死亡相对风险为1.55; 95% CI为1.07 - 2.24;安慰剂组与头孢地尼组的死亡相对风险为1.80; 95% CI为1.22 - 2.64）。在康复的儿童中，接受抗生素治疗的儿童体重增加率增加。严重急性营养不良的类型和干预组之间没有相互作用，无论是营养恢复率或死亡率。在单纯性严重急性营养不良的治疗方案中添加抗生素与恢复率和死亡率的显着改善相关。（由希基家庭基金会和其他人资助; ClinicalTrials.gov编号，NCT 01000298。
Severe acute malnutrition contributes to 1 million deaths among children annually. Adding routine antibiotic agents to nutritional therapy may increase recovery rates and decrease mortality among children with severe acute malnutrition treated in the community. In this randomized, double-blind, placebo-controlled trial, we randomly assigned Malawian children, 6 to 59 months of age, with severe acute malnutrition to receive amoxicillin, cefdinir, or placebo for 7 days in addition to ready-to-use therapeutic food for the outpatient treatment of uncomplicated severe acute malnutrition. The primary outcomes were the rate of nutritional recovery and the mortality rate. A total of 2767 children with severe acute malnutrition were enrolled. In the amoxicillin, cefdinir, and placebo groups, 88.7%, 90.9%, and 85.1% of the children recovered, respectively (relative risk of treatment failure with placebo vs. amoxicillin, 1.32; 95% confidence interval [CI], 1.04 to 1.68; relative risk with placebo vs. cefdinir, 1.64; 95% CI, 1.27 to 2.11). The mortality rates for the three groups were 4.8%, 4.1%, and 7.4%, respectively (relative risk of death with placebo vs. amoxicillin, 1.55; 95% CI, 1.07 to 2.24; relative risk with placebo vs. cefdinir, 1.80; 95% CI, 1.22 to 2.64). Among children who recovered, the rate of weight gain was increased among those who received antibiotics. No interaction between type of severe acute malnutrition and intervention group was observed for either the rate of nutritional recovery or the mortality rate. The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates. (Funded by the Hickey Family Foundation and others; ClinicalTrials.gov number, NCT01000298.)