Evidence to support current guidelines recommending routine antibiotic use in the outpatient management of uncomplicated severe acute malnutrition (SAM) is limited and based largely on data from historical inpatient settings. The evidence from 2 clinical trials on the effect of routine antibiotic use on nutritional recovery differs. In Malawi, where HIV and kwashiorkor prevalence are high, routine antibiotics increased nutritional recovery and decreased mortality.
In Niger, where HIV and kwashiorkor prevalence are low, we found no benefit of routine amoxicillin on nutritional recovery or mortality, although children receiving amoxicillin had a reduced risk of transfer to inpatient care.
Both reports only considered short-term risks and benefits during nutritional treatment (mean [SD] time to recovery, 29  days in Malawi and 29  days in Niger), although immunodeficiencies and risk of relapse or morbidity associated with SAM may persist beyond nutritional recovery.
To broaden the available evidence, we present the first analysis (to our knowledge) to assess the outcome of routine antibiotic use in outpatient SAM management, including follow-up during and after nutritional treatment.