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Title: The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials
Authors: Gough, Ethan K.
Moodie, Erica E. M.
Prendergast, Andrew J.
Johnson, Sarasa M. A.
Humphrey, Jean H.
Stoltzfus, Rebecca J.
Walker, A. Sarah
Trehan, Indi
Gibb, Diana M.
Goto, Rie
Tahan, Soraia [UNIFESP]
Morais, Mauro Batista de [UNIFESP]
Manges, Amee R.
McGill Univ
Zvitambo Inst Maternal Child Hlth Res
Queen Mary Univ London
Johns Hopkins Bloomberg Sch Publ Hlth
Cornell Univ
Washington Univ
Univ Malawi
Univ Cambridge
Universidade Federal de São Paulo (UNIFESP)
Univ British Columbia
Issue Date: 15-Apr-2014
Publisher: Bmj Publishing Group
Citation: Bmj-british Medical Journal. London: Bmj Publishing Group, v. 348, 13 p., 2014.
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.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.
ISSN: 1756-1833
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