The impact of antibiotics on growth in children in low and middle income countries: Systematic review and meta-analysis of randomised controlled trials
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe; Centre for Paediatrics, Blizard Institute, Queen Mary University of London, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Division of Nutritional Sciences, Program in International Nutrition, Cornell University, Ithaca, NY, United States; Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States; University of Malawi, Blantyre, Malawi; Division of Biological Anthropology, Department of Archaeology and Anthropology, University of Cambridge, United Kingdom; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
Objective:s To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect. Design: Systematic review and meta-analysis. Data sources: Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science. Study selection: Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention. Results: Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. In random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions. Conclusion Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. The antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations.
amoxicillin; antibiotic agent; cefdinir; chlortetracycline; cotrimoxazole; metronidazole; penicillin derivative; placebo; polymyxin B; rifaximin; secnidazole; sulfonamide; trimethoprim; antibiotic therapy; article; child growth; clinical effectiveness; developing country; drug efficacy; drug indication; giardiasis; human; infection prevention; meta analysis; opportunistic infection; prepuberty; priority journal; randomized controlled trial (topic); risk assessment; systematic review; treatment duration; treatment outcome; treatment planning; Anti-Bacterial Agents; Child; Child Development; Child, Preschool; Developing Countries; Growth Substances; Humans; Infant; Infant, Newborn; Randomized Controlled Trials as Topic