Evidence map›Paper›PMID 23363496›Full record

Trial reportThe New England journal of medicine2013

Antibiotics as part of the management of severe acute malnutrition.

Indi Trehan, Hayley S Goldbach, Lacey N LaGrone, Guthrie J Meuli, Richard J Wang, Kenneth M Maleta, Mark J Manary

4 registry-linked trialsOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 158 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
158citing papers in PubMed, 6 pooled it
33.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01000298 nacompletednot on this map

Randomized, Double-blind, Placebo-controlled Trial to Evaluate the Effectiveness of Oral Antibiotics in the Community-based Treatment of Severe Acute Malnutrition in Malawian Children

TypeinterventionalSponsorWashington University School of MedicineRan2009 to 2011Enrolled2,767ConditionsKwashiorkor, MarasmusArmsPlacebo, Amoxicillin, Cefdinir
NCT02414399 phase4unknown statusnot on this mapstarted 2016, after this paper: background citation

Azithromycin to Prevent Post-discharge Morbidity and Mortality in Kenyan Children

TypeinterventionalSponsorUniversity of WashingtonRan2016 to 2025Enrolled1,400ConditionsPneumonia, Diarrhea, Malaria, Co-infectionArmsAzithromycin, Placebo
NCT02746276 phase2unknown statusnot on this mapstarted 2016, after this paper: background citation

Pharmacokinetics of Antimicrobials and Carriage of Antimicrobial Resistance Amongst Hospitalised Children With Severe Acute Malnutrition

TypeinterventionalSponsorUniversity of OxfordRan2016 to 2017Enrolled81ConditionsMalnutritionArmsCeftriaxone, Metronidazole
NCT03174236 phase3unknown statusnot on this mapstarted 2017, after this paper: background citation

First Line Antimicrobials in Children With Complicated Severe Acute Malnutrition

TypeinterventionalSponsorUniversity of OxfordRan2017 to 2020Enrolled2,000ConditionsMalnutrition Severe, Antibiotic Resistance, Antibiotic ToxicityArmsCeftriaxone, Benzyl penicillin, Metronidazole, Placebo, Gentamicin
3 · Its place in the literature

Who cites it

158 citing papers in PubMed, 6 syntheses or guidelines pooled it, 344 citations in OpenAlex.

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  3. Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015
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98 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 2 countries.

Indi TrehanDepartment of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA.
Hayley S Goldbach
Lacey N LaGrone
Guthrie J Meuli
Richard J Wang
Kenneth M Maleta
Mark J Manary
Washington University in St. Louis · USAgricultural Research Service · USCornell University · USUniversity of Malawi · MWUniversity of Pennsylvania · USUniversity of Washington · US

Funding

Washington University Institute of Clinical and Translational Sciences (UL1)UL1RR024992 · NCRR · WASHINGTON UNIVERSITY · PI EVANOFF, BRADLEY A · 2007 to 2011
$45.4M
Washington University Institute of Clinical and Translational SciencesUL1TR000448 · NCATS · WASHINGTON UNIVERSITY · PI EVANOFF, BRADLEY A · 2012 to 2016
$41.4M
Training of the Pediatric Emergency Physician-ScientistT32HD049338 · NICHD · WASHINGTON UNIVERSITY · PI SCHNADOWER, DAVID · 2007 to 2016
$1.3M
NCATS NIH HHS UL1 TR000448NCRR NIH HHS UL1 RR024992NCRR NIH HHS UL1-RR024992NICHD NIH HHS T32 HD049338NICHD NIH HHS T32-HD049338
6 · The paper itself

Abstract

backgroundSevere 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.

methodsIn 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.

resultsA 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.

conclusionsThe 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.).

Indexed as

Acute DiseaseAmoxicillinAnti-Bacterial AgentsCefdinirCephalosporinsChild, PreschoolCombined Modality TherapyDouble-Blind MethodFemaleHumansInfantKaplan-Meier EstimateMaleProtein-Energy MalnutritionRiskTreatment OutcomeAmoxicillinAnti-Bacterial AgentsCefdinirCephalosporins

Identifiers

PMID23363496
PMCPMC3654668
OpenAlexW2137247340

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.