Kemri-Wellcome Trust Research Programme: First Line Antimicrobials in Complicated Severe Acute Malnutrition: FLACSAM

Children with severeacute malnutrition (SAM) who are admitted to hospitals in sub-Saharan Africa have infective ormetabolic complications, rather than being admitted for malnutrition alone. They have a very highinpatient mortality, usually from overwhelming bacterial sepsis. Microbiological data are limited bybeing from very few sites and by the inherent low sensitivity of blood cultures. However, theavailable data suggest that microbial resistance to the currently recommended empiric first-lineantibiotics given to all malnourished children is widespread and is increasing. Because of theirextreme vulnerability, seriously ill children with SAM, with or without HIV, may be more likely to dieas a result of antimicrobial resistance, rather than simply have an extended hospital stay.Altering the empiric first-line antibiotics to include ceftriaxone and metronidazole could potentiallysave lives, hasten nutritional recovery and reduce costs. However, ceftriaxone is known to induceincreased antimicrobial resistance to multiple antibiotic classes. The key question is whethermortality is reduced by altering the empiric antimicrobials. If not, then policymakers will be able togive clear guidance against their use in this context. However, if there is a mortality benefit, thenpolicymakers will need information on antimicrobial resistance to give clear guidance onantimicrobial stewardship, costs and further monitoring of trends

Programme: Joint Global Health Trials Award

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