Just some add on information to the previous posts.

In addition to the reasons previously posted, antimicrobials are recommended for the treatment in outpatients with SAM due to a reduction in mortality from 7.48% to 6.43%. The WHO guideline update (2013) recommends antimicrobials to be given even at the risk of increasing antimicrobial resistance at community level. See the update for full details.

In some contexts it has been suggested to use Co-Amoxiclav (Amoxicillin-Clavulanic Acid) where there is a problem of resistance to amoxicillin. Cefotaxime or Cefexime may be useful alternatives in the inpatient setting for complicated cases. The choice of 1st line antimicrobial should be consistent with other national guidelines (e.g. IMCI). Any decision to change the 1st line should only be done at Ministry level following review of the local evidence for resistance.

Where supply issues are the problem other antimicrobials have been used and may include co-trimoxazole, however it is suggested that this is not effective against the small bowel flora seen in SAM cases and therefore is unsuitable. Given that this action against small bowel flora is thought to be the mechanism underlying the reduction in mortality it is not to be recommended. There may also be problems with resistance to this antimicrobial too. If it is given it should be a temporary solution of last resort and should not be considered the preferred therapy. All possible efforts should be made to correct the logistical problems preventing the appropriate antibiotic from being available.

As Mark has said, during T2 and T3 the pregnancy is more easily visible, however nutritional support can be given one the pregnancy has been diagnosed by a physician or midwife even if it before this period. The addition requirements during each trimester are:
1st Trimester 85 kcal / day
2nd Trimester 285 kcal / day
3rd Trimester 475 kcal

For breastfeeding mothers the additional energy requirement for the first 6 months is:
If well nourished 500 kcal / day
If malnourished 675 kcal /day
(source: FAO / WHO, 2004)

I hope this helps.

It is advisable to give anticlbiotics to SAM children outpatients under care .

As our colleagues stated above, antibiotics are important for children with SAM admitted in OTP centers to improve the recovery and to reduce mortality rate. Moreover, Amoxicillin has a broad spectrum antimicrobial effect against against most enteric microorganisms.

In a recent randomized placebo-controlled trial published in 2014 and implemented between 2009-2011 in Malawi, 2767 SAM children enrolled into the OTP programme and categorized into 3 groups: The first one was given RUTF+Amoxicillin, Second on RUTF+Cefdinir(third generation Cephalosporin) and the third on RUTF+Placebo for the first week of admission for each group.
They have found that 88.7%, 90.0% and 85% of the children recovered respectively, we can notice the better recovery outcomes for children with Amoxcillin and Cefdinir, but at the same time children with placebo has 85% recovery rate which is close to that of Amoxicillin category. However, the mortality rate found to be higher in these patients (with placebo) with 7.4% mortality rate compared to 4.8% and 4.1% for each Amoxicillin and Cefdinir group.

Please have a look here for more details :
http://www.nejm.org/doi/full/10.1056/NEJMoa1202851(full article)
and also here :http://www.fantaproject.org/sites/default/files/resources/FANTA-Impact-CMAM-Antibiotics-May2014_0.pdf

Thanks,

Sameh

I would like to thank all the repliers to the first post. I do have a very similar request: anyone can give me some reference on the use of antibiotic for adult SAM? Not for PWL, but for adult male/women

Thank you in advance

D6d82N https://www.genericpharmacydrug.com