The impact of antibiotics on growth in children in low and middle-income
countries: systematic review and meta-analysis of randomized controlled trials
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 were conducted in low or middle-
income countries in which an orally administered antibacterial agent was
allocated by randomization or minimization 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 randomized 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. A better definition of the mechanisms
underlying this effect will be important to inform optimal and safe approaches
to achieving healthy growth in vulnerable populations.
countries: systematic review and meta-analysis of randomized controlled trials
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 were conducted in low or middle-
income countries in which an orally administered antibacterial agent was
allocated by randomization or minimization 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 randomized 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. A better definition of the mechanisms
underlying this effect will be important to inform optimal and safe approaches
to achieving healthy growth in vulnerable populations.
