Azithromycin versus Amoxicillin and Malarial Parasitemia among Children with Uncomplicated Severe Acute Malnutrition: A Randomized Controlled Trial

Sié, Ali; Dah, Clarisse; Millogo, Ourohiré; Ouédraogo, Moussa; Boudo, Valentin; Arzika, Ahmed M.; Lebas, Elodie; Nyatigo, Fanice; Arnold, Benjamin F.; O’Brien, Kieran; Oldenburg, Catherine E.

doi:10.4269/ajtmh.21-0595

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…According to the m<40 years FG few know how to do this (though it included one of them). One stated pharmaceutical treatment used was amoxicillin which is not an antimalarial drug 21. A FG and KI described how hospital treatment was sometimes sought for severe cases, using Binatang Research Centre transport when available.…”

Section: Resultsmentioning

confidence: 99%

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Middleton,

Colthart,

Dem

et al. 2023

BMJ Open

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ObjectivesDetermine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development.DesignClinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases.SettingWanang (pop. c189), a rainforest community in Madang province, Papua New Guinea.Participants129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f<40 years; m<40 years; f>40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded.ResultsOf 113 examined, 11 were ‘well’ (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) ‘malaria’, (B) ‘sotwin’, (C) ‘grile’) translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning.ConclusionsThis study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang’s community to develop sustainably, without sacrificing their forest home.

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Section: Resultsmentioning

confidence: 99%

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Middleton,

Colthart,

Dem

et al. 2023

BMJ Open

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“…Looking back at previous studies, a lot of studies conducted comparative analysis with erythromycin, azithromycin, and other treatments in the treatment of pediatric diseases, and these studies also clearly pointed out that the effectiveness of AZM was higher than that of erythromycin. [ 31 – 33 ] As others reported, AZM is an antibacterial drug with several advantages, including longer half-life time, better tolerance and therapeutic effect, and fewer contraindications and adverse reactions, and these advantages make AZM a preferred drug and extensively used in children with respiratory diseases. [ 34 , 35 ]…”

Section: Discussionmentioning

confidence: 99%

Safety profiles and adverse reactions of azithromycin in the treatment of pediatric respiratory diseases: A systematic review and meta-analysis

Sun,

Cen,

Chen

et al. 2023

Medicine

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Background: Azithromycin (AZM) is an antimicrobial agent and frequently used in the treatment of pediatric respiratory diseases due to its well-recognized clinical efficacy. Despite some favorable findings from many studies, there is a lack of research reports focusing on the safety profiles and adverse reactions. Methods: The randomized controlled trials of AZM in the treatment of pediatric respiratory diseases on internet databases were searched. The search databases included Chinese CNKI, Wanfang, VIP, PubMed, EMBASE, and Cochrane Library. Two researchers of this study independently assessed the eligibility, risk of bias, and extracted the data. The included literature was meta-analyzed and subgroup analyzed by revman 5.1 software. Results: A total of 14 eligible studies were included. The results of meta-analysis showed that the incidence of adverse reactions after AZM treatment was 24.20%, which was lower than 48.05% in the control group (OR = 0.42, 95% CI 0.12–0.72, P < .001). In the subgroup of sequential therapy, AZM had a lower incidence of adverse reactions in sequential therapy (OR = 0.29, 95% CI 0.09–0.60, P < .001). In the subgroup of intravenous administration, AZM had a lower the incidence of adverse reactions (OR = 0.57, 95% CI 0.12–0.84, P = .003). In the subgroup of oral administration, AZM had a lower the incidence of adverse reactions (OR = 0.45, 95% CI 0.13–0.69 P < .001). Overall, it was also found that the incidence of adverse reactions in the AZM subgroup was significantly lower than that in other treatment subgroup. Conclusion: AZM has fewer adverse reactions and better safety profiles, which make AZM a more attractive option in the treatment of pediatric respiratory diseases.

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“…Although WAZ and HAZ do not have the benefits of MUAC for ease of screening in community‐based settings, WAZ is easier to measure than WHZ or HAZ because it does not require a height measurement. Theoretically, children could be measured in the field relatively easily and WAZ could be calculated based on the weight measure and the child's age (Sié, Dah, et al, 2021 ; Sié, Ouattara et al, 2021 ). Nearly all children in this cohort had WAZ < −2; however, because all children had SAM, it is unclear how many children who would not meet the current SAM criteria would be admitted to the nutritional programme using that WAZ cutoff.…”

Section: Discussionmentioning

confidence: 99%

“…Nutritional recovery was defined per Burkinabè guidelines as WHZ ≥ −2 and/or MUAC ≥ 12.5 cm on two consecutive visits, based on the criterion used for enrolment. A rapid diagnostic test (RDT) for malaria was performed on all children at 8 weeks after enrolment (Sié, Dah, et al, 2021 ). At each study time point, caregivers were interviewed to assess if their child had experienced any fever or diarrhoea since the last study visit.…”

Section: Methodsmentioning

confidence: 99%

How does baseline anthropometry affect anthropometric outcomes in children receiving treatment for severe acute malnutrition? A secondary analysis of a randomized controlled trial

Dah

Millogo

Sié

et al. 2022

Maternal & Child Nutrition

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Mid-upper arm circumference (MUAC) < 11.5 cm and weight-for-height Z-score (WHZ) < −3 are used for screening for severe acute malnutrition (SAM). Underweight and concurrent wasting and stunting may better target those at the highest risk of mortality. We compared anthropometric outcomes in children enrolled in a trial of antibiotics for SAM based on categories of baseline anthropometry, including indicators for programme admission (WHZ < −3, MUAC < 11.5) and alternative indicators (weight-forage Z-score [WAZ] < −3, concurrent wasting and stunting [WHZ < −3 and height-for-age Z-score < −3]). Participants were followed weekly until nutritional recovery and at 8 weeks. We evaluated changes in weight gain (g/kg/day), MUAC, and WHZ in children admitted by admissions criteria (MUAC only, WHZ only, or MUAC and WHZ) and by underweight or concurrent wasting and stunting. Of 301 admitted children, 100 (33%) were admitted based on MUAC only, 41 (14%) WHZ only, and 160 (53%) both MUAC and WHZ, 210 (68%) were underweight and 67 (22%) were concurrently wasted/stunted. Low MUAC and low WHZ children had the lowest probability of nutritional recovery (17% vs. 50% for MUAC-only and 34% for WHZ-only). There was no difference in weight gain velocity or WHZ by admissions criteria (WHZ and/or MUAC). Underweight and concurrently wasted/stunted children had lower MUAC and WHZ at 8 weeks compared with those who were not underweight or concurrently wasted and stunted. Children with both low MUAC and low WHZ had the worst outcomes. Relying on MUAC alone may miss children who have poor outcomes. Other indicators, such as WAZ, may be useful for identifying vulnerable children.

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Azithromycin versus Amoxicillin and Malarial Parasitemia among Children with Uncomplicated Severe Acute Malnutrition: A Randomized Controlled Trial

Cited by 5 publications

References 19 publications

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Safety profiles and adverse reactions of azithromycin in the treatment of pediatric respiratory diseases: A systematic review and meta-analysis

How does baseline anthropometry affect anthropometric outcomes in children receiving treatment for severe acute malnutrition? A secondary analysis of a randomized controlled trial

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