Downloaded from http://adc.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Review
ARCHIVIST
Do antibiotics make children grow?
In agricultural animal-rearing, antibiotics have been used for some years, controversially, to promote growth and increase profits. Could the same principle apply to humans? An international team of authors, acknowledging the important link between sustained growth and favourable health outcomes, examined the evidence for whether this principle could apply to children in developing countries (Gough EK and colleagues. BMJ 2014;348:g2267). Perhaps surprisingly, they found 10 trials of sufficient quality, spanning 6 decades, to be included in their meta-analysis. There was a wide variety of inclusion criteria and antibiotics used. Nine studies compared to placebo, and one to nothing. Treatment and follow-up periods varied enormously. Only one involved HIV–positive children. The net cumulative beneficial effects on height amounted to 0.04 cm/month, and on weight to 23.8g/ month. The effect seemed greater for weight than for height, for younger children, and for studies done in Africa. If this effect was sustained over a whole 15 years of growth, antibiotics could, in theory, make children 7.2 cm taller and 4.3 kg heavier. A recent randomised controlled trial not included in this meta-analysis came from Malawi, where researchers added antibiotics (amoxicillin or cefdinir) or placebo to their existing severe acute malnutrition treatment regime (Trehan I and colleagues. N Engl J Med 2013;368:425–35). The study involved over 2750 children less than 3 years of age. Antibiotics produced a significant improvement in mortality (RR of death for placebo vs. cefdinir 1.8; 95% CI 1.22–2.64), and improved recovery rates. Weight gain was modestly but significantly superior for the antibiotic-treated groups. An editorial by Zulfiqar Bhutta accompanying the BMJ article urges caution in over-interpreting it (BMJ 2014;348:g2624). Lumping together such diverse studies may not be justified: for example, two looked at metronidazole for giardia, which might not even be pathogenic. Preventing frequent debilitating infections in susceptible populations in order to optimise growth potential appears an attractive prospect, but emerging resistance is already a problem in low-income countries, and could be worsened by more widespread use. Bhutta recommends using existing research structures designed to assess growth, such as the Mal-ED studies, to assess antibiotic use more rigorously. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Accepted 3 May 2014 Published Online First 15 May 2014 Arch Dis Child 2014;99:685. doi:10.1136/archdischild-2014-306698
Sen ES, et al. Arch Dis Child 2014;99:679–685. doi:10.1136/archdischild-2013-304396
685
Downloaded from http://adc.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Do antibiotics make children grow?
Arch Dis Child 2014 99: 685 originally published online May 15, 2014
doi: 10.1136/archdischild-2014-306698 Updated information and services can be found at: http://adc.bmj.com/content/99/7/685
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To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Review
ARCHIVIST
Do antibiotics make children grow?
In agricultural animal-rearing, antibiotics have been used for some years, controversially, to promote growth and increase profits. Could the same principle apply to humans? An international team of authors, acknowledging the important link between sustained growth and favourable health outcomes, examined the evidence for whether this principle could apply to children in developing countries (Gough EK and colleagues. BMJ 2014;348:g2267). Perhaps surprisingly, they found 10 trials of sufficient quality, spanning 6 decades, to be included in their meta-analysis. There was a wide variety of inclusion criteria and antibiotics used. Nine studies compared to placebo, and one to nothing. Treatment and follow-up periods varied enormously. Only one involved HIV–positive children. The net cumulative beneficial effects on height amounted to 0.04 cm/month, and on weight to 23.8g/ month. The effect seemed greater for weight than for height, for younger children, and for studies done in Africa. If this effect was sustained over a whole 15 years of growth, antibiotics could, in theory, make children 7.2 cm taller and 4.3 kg heavier. A recent randomised controlled trial not included in this meta-analysis came from Malawi, where researchers added antibiotics (amoxicillin or cefdinir) or placebo to their existing severe acute malnutrition treatment regime (Trehan I and colleagues. N Engl J Med 2013;368:425–35). The study involved over 2750 children less than 3 years of age. Antibiotics produced a significant improvement in mortality (RR of death for placebo vs. cefdinir 1.8; 95% CI 1.22–2.64), and improved recovery rates. Weight gain was modestly but significantly superior for the antibiotic-treated groups. An editorial by Zulfiqar Bhutta accompanying the BMJ article urges caution in over-interpreting it (BMJ 2014;348:g2624). Lumping together such diverse studies may not be justified: for example, two looked at metronidazole for giardia, which might not even be pathogenic. Preventing frequent debilitating infections in susceptible populations in order to optimise growth potential appears an attractive prospect, but emerging resistance is already a problem in low-income countries, and could be worsened by more widespread use. Bhutta recommends using existing research structures designed to assess growth, such as the Mal-ED studies, to assess antibiotic use more rigorously. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Accepted 3 May 2014 Published Online First 15 May 2014 Arch Dis Child 2014;99:685. doi:10.1136/archdischild-2014-306698
Sen ES, et al. Arch Dis Child 2014;99:679–685. doi:10.1136/archdischild-2013-304396
685
Downloaded from http://adc.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Do antibiotics make children grow?
Arch Dis Child 2014 99: 685 originally published online May 15, 2014
doi: 10.1136/archdischild-2014-306698 Updated information and services can be found at: http://adc.bmj.com/content/99/7/685
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
