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Isanaka S, Grantz KH, Berthé F, Schaefer M, Adehossi E, Grais RF. Extended Follow-up From a Randomized Clinical Trial of Routine Amoxicillin in the Treatment of Uncomplicated Severe Acute Malnutrition in Niger. JAMA Pediatr. Published online January 13, 2020. doi:10.1001/jamapediatrics.2019.5189
Evidence to support current guidelines recommending routine antibiotic use in the outpatient management of uncomplicated severe acute malnutrition (SAM) is limited and based largely on data from historical inpatient settings.1 The evidence from 2 clinical trials2,3 on the effect of routine antibiotic use on nutritional recovery differs. In Malawi, where HIV and kwashiorkor prevalence are high, routine antibiotics increased nutritional recovery and decreased mortality.2 In Niger, where HIV and kwashiorkor prevalence are low, we found no benefit of routine amoxicillin on nutritional recovery or mortality, although children receiving amoxicillin had a reduced risk of transfer to inpatient care.3
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