The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials

Abstract

Objectives 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. ConclusionAntibiotics 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.

Antibiotic Exposure in Infancy and Risk of Being Overweight in the First 24 Months of Life

“…Severely malnourished infants have been shown to gain weight faster when they are given antibiotics, [12][13][14][15] and similar findings have been only recently reported in well-nourished children in affluent Western countries. [7][8][9][10][11] Antibiotics increase body fat mass in mice, which is assumed to result from changes in composition of the intestinal microbial flora.…”

“…In children with severe malnutrition or chronic infections such as HIV, several studies have shown that both weight gain and linear growth in height improved with antibiotic therapy. [12][13][14][15] However, the effect of early antibiotic exposure on height in healthy, well-nourished children has not been adequately elucidated. [7][8][9][10][11] In the present population-based study, we aimed to evaluate the impact of antibiotic exposure during the first 24 months of age on weight and height gain in healthy Finnish children carefully screened for other risk factors and chronic conditions potentially affecting linear growth.…”

The effect of azithromycin on the immunogenicity of oral poliovirus vaccine: a double-blind randomised placebo-controlled trial in seronegative Indian infants

“…Indeed, antibiotics are known to promote growth in malnourished children. 29 The mechanisms of action are not known, although reduction in intestinal inflammation and resolution of EE may play an important role.…”

Childhood Obesity, Breastfeeding, Intestinal Microbiota, and Early Exposure to Antibiotics

“…Antibiotics were found to induce a growth-promoting effect in prepubertal children, possibly by altering their IM. 4 The neonatal IM composition is influenced by prenatal and postnatal antibiotic exposure 5 and other age-specific modifiers such as mode of delivery (natural birth vs cesarean delivery) and mother-to-infant transfer of bacterial strains and human milk oligosaccharides via breastfeeding. The latter are structurally diverse unconjugated glycans that are highly abundant in and unique to human milk; they can stimulate the growth and/or activity of healthy intestinal bacteria.…”