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Routine antibiotics for infant growth failure: A systematic review

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This is a summary of the following paper: Imdad A, Chen F, François M et al. (2023) Routine antibiotics for infants less than 6 months of age with growth failure/faltering: A systematic review. BMJ Open, 13, e071393. https://bmjopen.bmj.com/content/bmjopen/13/5/e071393.full.pdf

 

Malnutrition is both a driver of and exacerbating factor for infections. When children aged 6–59 months enter nutrition programmes, they are regularly prescribed routine antibiotics to counter this.

“This practice in infants has the potential to harm due to recently identified risks of antibiotic use in infancy, including the diminishment of infant gut microbiome”

This systematic review followed Cochrane Handbook1 guidance and included individual and cluster randomised trials, as well as non-randomised trials and cohort studies with control groups. Case-control, case reports, case series, and commentaries were excluded. The objective was to compare the effect of no routine antibiotics (or alternative regimens) against routine antibiotic prescription following treatment in infants aged under six months with growth failure or faltering (Box 1).

Studies in both hospital and community settings were considered, but neonatal intensive care and congenital anomaly study populations were excluded. Antibiotic regimens and doses varied between studies, but only oral or intravenous administration was included.

Box 1: Study outcomes

  • Mortality
  • Clinical deterioration
  • Recovery from comorbidity
  • Markers of intestinal inflammation-serum C reactive protein
  • Hospital-acquired infections
  • Non-response

Of 5,137 screened studies, 157 were deemed eligible for full-text review. None of these 157 studies qualified for inclusion in this review for the following reasons: ineligible study design (n=85), patient population (55), comparison group (7), intervention (8), and indicators (2).

Despite a robust methodology, the fact that not a single study was eligible highlights the paucity of evidence in this area. The researchers could have broadened their search criteria from aged under six months to under five years, which may have yielded results, but this would have answered a different study question for a different population.

It is unusual to see a systematic review with no evidence to draw upon, yet this is an important finding. Publication bias is a well-known phenomenon in health research – where so-called ‘null’ findings often do not make it to print. This article highlights the importance of featuring such work, as it flags the need for researchers to investigate the potential risks and benefits of antibiotic use in this population, with large sample sizes and robust methods. In summary, we now know what we don’t know.

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Routine antibiotics for infant growth failure: A systematic review. Field Exchange 71, December 2023. p24. www.ennonline.net/fex/71/routine-antibiotics-for-infant-growth-failure-a-systematic-review

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