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Effect of Antibiotics on Short-Term Growth among Children in Burkina Faso: A Randomized Trial

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  • 1 Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso;
  • 2 Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany;
  • 3 Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts;
  • 4 Africa Health Research Institute, KwaZulu-Natal, South Africa;
  • 5 Francis I. Proctor Foundation, University of California, San Francisco, California;
  • 6 The Carter Center, Niamey, Niger;
  • 7 Department of Ophthalmology, University of California, San Francisco, San Francisco, California;
  • 8 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California

Antibiotics improve both weight and height gain in randomized trials of preschool children with preexisting morbidity. Here, we assess the effect of a short course of three different antibiotics (amoxicillin, azithromycin, and cotrimoxazole) on short-term linear and ponderal growth in a population-based sample of preschool children in rural Burkina Faso. We randomized households with at least two children in the Nouna district, Burkina Faso, to a 5-day course of amoxicillin, azithromycin, cotrimoxazole, or placebo. Within each antibiotic-randomized household, one child was randomly assigned to receive the antibiotic and the other to receive the placebo. Weight and height measurements were taken at baseline and 30 days following the last study medication dose. Weight-for-height Z (WHZ), height-for-age Z (HAZ), and weight-for-age Z (WAZ) scoreswere calculated based on the 2006 World Health Organization standards. Of the 124 households and 248 children enrolled, 229 had anthropometry measurements at 1 month and were analyzed. Children randomized to amoxicillin gained significantly more weight compared with both the placebo household (mean difference 317 g, 95% confidence interval [CI]: 115–519 g) and placebo sibling (mean difference 315 g, 95% CI: 147–482 g) controls. Growth velocity in g/kg/day, and WHZ and WAZ scores were higher in amoxicillin-treated children compared with placebo households and siblings. There were no differences in weight gain in children randomized to azithromycin or cotrimoxazole compared with placebo households or placebo siblings. There were no differences in height gain or HAZ across any of the study arms. Amoxicillin may have short-term growth-promoting effects in healthy children.

Author Notes

Address correspondence to Catherine E. Oldenburg, Francis I. Proctor Foundation, University of California, San Francisco, 513 Parnassus Ave., Rm. S334, San Francisco, CA 94143. E-mail: catherine.oldenburg@ucsf.edu

Financial support: This work was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professorship endowed by the German Federal Ministry of Education and Research (to T. B.).

Authors’ addresses: Ali Sié, Clarisse Dah, Lucienne Ouermi, Charlemagne Tapsoba, and Pascal Zabre, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso, E-mails: sieali@yahoo.fr, n.clarissedah@yahoo.fr, ouermil@yahoo.fr, charlemagnetapsoba@gmail.com, and erbazson@gmail.com. Till Bärnighausen, Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany, E-mail: till.baernighausen@uni-heidelberg.de. Elodie Lebas, Blake M. Snyder, Travis C. Porco, Thomas M. Lietman, and Catherine E. Oldenburg, Francis I. Proctor Foundation, University of California, San Francisco, CA, E-mails: elodie.lebas@ucsf.edu, blake.snyder@ucdenver.edu, catherine.oldenburg@ucsf.edu, travis.porco@ucsf.edu, and tom.lietman@ucsf.edu. Ahmed M. Arzika, The Carter Center, Niamey, Niger, E-mail: mamaneahmed@yahoo.fr. Jeremy D. Keenan, Francis I. Proctor Foundation, University of California, San Francisco, CA, and Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, E-mail: jeremy.keenan@ucsf.edu.

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