No survival benefit of antibiotics addition to WHO protocol in infants with watery diarrhea: JAMA

Delhi: The addiiton of azithromycin to standard World Health Organization (WHO) treatment protocols in children with acute watery diarrhea is not associated with a detectable survival benefit, show findings from a recent study. This indicates that in low-resource settings, antibiotic use is not warranted and the adherence to current WHO case management protocols is appropriate and should be encouraged. The study was published in JAMA Network Open on December 16, 2021. 

WHO guidelines do not recommend routine use of antibiotics for children with children with acute watery diarrhea. However, some studies have suggested a bacteria may be the cause in a significantly proportion of such episodes and is associated with mortality and growth impairment, esprcua;;y in children at high mortality risk due to diarrhea. It is suggested that expanding antibiotic in undernourished or dehydrated children may improve growth and reduce diarrhea-associated mortality. 

Against the above background, Rajiv Bahl and colleagues from the Antibiotics for Children With Diarrhea (ABCD) Study Group, aimed to etermine whether azithromycin addition to standard case management of acute nonbloody watery diarrhea for children (aged 2 to 23 months) who are dehydrated or undernourished could reduce mortality and improve linear growth.

ABCD trial was a multicountry, randomized, double-blind, clinical trial that included 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea, recruited between July 1, 2017, and July 10, 2019. The recruitment was done from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. The participants were followed up for 180 days. Primary analysis included all randomized participants by intention to treat.

Children who were enrolled in the study in addition to standard WHO case management protocols for the management of acute watery diarrhea, 8266 children (4463 boys [54.0%]; mean age, 11.6 months) were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days. 

Primary outcomes was all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. 

The authors concluded, the results support rigorous adherence to the current WHO guidelines on the management of diarrhea and do not suggest that a change to global diarrhea management guidelines or policy is merited.

Reference:

The Antibiotics for Children With Diarrhea (ABCD) Study Group. Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(12):e2136726. doi:10.1001/jamanetworkopen.2021.36726