Meta-analysisindependent cross-checkabstract checked★ key study I-ABX-111 in-depth review
Antibiotics helped children in poorer countries grow
The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials.
Overview
Gough EK et al.. BMJ 2014 · PMID 24735883 · DOI 10.1136/bmj.g2267
In randomised trials, children given antibiotics gained about 24 g more per month.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Test antibiotic effects on child growth
- How was the study done?
Meta-analysis of 10 randomised trials
- How many people, animals or samples were studied?
4316 children in LMICs
- What was actually found?
Slightly more weight and height gain
- How large was the observed effect?
+23.8 g/month
- What do the results mean in everyday life?
In undernourished children this is a benefit
- What are the study's limitations?
Different setting from obesity
- What does it say about Elawady's specific claim?
Partly supports 'antibiotics increase weight'; not 'cause obesity'
- Do the results apply to Germany and Europe?
Low
- What can explicitly not be concluded from this study?
Effect in well-fed children
Scientific in-depth review
1. Full reference
- Authors
- Gough EK et al.
- Journal
- BMJ
- Year
- 2014
- Identifier
- PMID 24735883 DOI 10.1136/bmj.g2267
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Wellcome Trust; authors declare no competing interests (PubMed record).
2. Research question
Does antibiotic treatment improve growth of prepubertal children in low- and middle-income countries?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of RCTs
- Population
Children aged 1 month-12 years in LMICs
- Country
Multiple LMICs
- Period
Database searches to 2013
- Sample size
10 RCTs, 4316 children
- Inclusion and exclusion criteria
RCTs with oral antibacterial vs placebo/non-antimicrobial control and growth outcome
4. Methods and endpoints
- Exposure / intervention
Oral antibiotics
- Comparator
Placebo or no antimicrobial
- Endpoints
Height and weight gain
- Statistical methods
Random-effects meta-analysis
5. Actual results
- Results
Antibiotics increased height by 0.04 cm/month (95% CI 0.00-0.07) and weight by 23.8 g/month (4.3-43.3); weight effects larger in African studies.
- Absolute risks
23.8 g/month (about 286 g/year, recalculated)
- Authors' conclusion
Antibiotics have a growth-promoting effect in prepubertal children in LMICs, possibly via treatment of (sub)clinical infections or microbiota modulation.
6. Strengths
- Randomised evidence
- Direct test of antibiotic effect on weight
7. Weaknesses
- LMIC, often undernourished, infection-burdened children
- Growth, not obesity
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- low
- Rationale
RCT-based; heterogeneity in drugs and indications.
9. Assessment of the statistical interpretation
Causal evidence that antibiotics can increase weight gain in at-risk children; this is desirable growth, not obesity.
10. Relevance to the specific claim
Gives the strongest causal support for 'antibiotics increase weight', but in undernourished children where this is a benefit.
11. Independent contrary findings
Does not show obesity in well-nourished children; mechanism may be treating infections.
12. Transferability to Germany and Europe
Low for well-nourished European/Egyptian children.
13. Overall methodological judgement
Antibiotics can increase weight gain (an effect analogous to livestock growth promotion), but this does not establish obesity risk.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | low |
| Precision of results | moderate |
| Directness | indirect |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | low |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Whether the effect exists in well-nourished children.