The Effect of Antibiotic Treatment of Subclinical Enteric Infection on Child Growth in the MAL-ED Cohort Study Public
Anderson, Simone (Spring 2024)
Published
Abstract
Background: Stunting is prevalent in low- and middle-income countries. In the long term, it can lead to cognitive impairment and increased risk for infectious diseases. Diarrheal diseases in children under five have been found to decrease length-for-age and weight-for-age z-scores leading to stunting in the long term. Subclinical infection of these diseases may have a larger effect on this deficit. Antibiotics may have a positive impact on child growth. We wanted to see the effect of antibiotic treatment on these subclinical infections and its relationship to child growth.
Methods: We identified our 5 pathogens of interest in non-diarrheal stool samples collected monthly from children in the cohort. We defined an infection as treated if a child received antibiotics in the 7 days before or after the stool sample was collected. We evaluated the effect on length-for-age, weight-for-age, and weight-for-length z-scores 3 months, 6 months, and 2 years after infection. We used linear regression with generalized estimating equations to estimate the effect of antibiotic use on the infection for the 3- and 6-month z-scores. At 2 years, we used linear regression to assess the proportion of infections treated.
Results: Differences in z-score varied by both pathogen type and antibiotic class. Treatment of ETEC resulted in significant differences in WAZ and WFL when treated with fluoroquinolones or macrolides. Use of fluoroquinolones had the greatest differences in z-scores. Treatment of Shigella with cephalosporins resulted in significant negative differences in LAZ. Z-score differences 6 months after infection were slightly larger than those at 3 months. There were very small impacts of antibiotic use at 2 years after infection.
Conclusions: We found that antibiotic treatment had a larger impact on weight than length There appeared to be a larger effect on short term growth outcomes than long term growth. Other methods are needed to reduce the global burden of stunting.
Table of Contents
Introduction ...................... 1
Methods ............................ 2
Results .............................. 5
Discussion ......................... 8
Figures .............................. 11
References ......................... 17
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