A 2-year-old is admitted with SAM (severe acute malnutrition) — weight for height z-score −3.5, bilateral pitting pedal edema, and sparse reddish hair. He develops fever 48 hours post-admission with no localizing signs. C-reactive protein is elevated. The MOST appropriate antibiotic approach for this child per WHO SAM management protocol is:
- A No antibiotics unless a specific infection source is identified on examination
- B Amoxicillin orally for 5 days regardless of signs of infection
- C Ampicillin + gentamicin IV for 7 days empirically ✓
- D Ceftriaxone IV + metronidazole for 10 days
Explanation
WHO SAM management protocol (Phase 1) mandates empirical broad-spectrum antibiotics for all hospitalized SAM children regardless of whether a specific infection is identified, because infection signs (fever, WBC elevation) are often absent or blunted in immunocompromised malnourished children, yet bacteremia risk is high. IV ampicillin + gentamicin for 7 days is the recommended empirical regimen (covers Gram-positive, Gram-negative bacteria and enteric organisms). If no improvement at 48-72 hours, ceftriaxone is substituted. Amoxicillin orally is used in uncomplicated SAM managed in the community. Withholding antibiotics in hospitalized SAM risks septic shock.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.