Prophylaxis antibiotics: No clinical benefit for breastfed HEU infants

Researchers at the University of KwaZulu-Natal, supported by the HIV Prevention Research Unit of the South African Medical Research Council and FLRF, find prophylaxis antibiotics provided no clinical benefit for breastfed infants that were HIV-exposed but uninfected (HEU) in warding off communicable diseases and death.

The randomized controlled, non-inferiority trial was launched by the university’s Department of Paediatrics and Child Health, School of Clinical Medicine in South Africa to test the current World Health Organization (WHO) recommendation that HEU infants receive co-trimoxazole until they are weaned to prevent common childhood illnesses (pneumonia and diarrhea) and mortality.

Their findings suggest the WHO recommendation may require revision; full details have just been published in this open-access article in the December 2019 issue of The Lancet Global Health.

“Given the increased data showing possible immune disruption and damage caused by interference with the microbiome, it is possible that co-trimoxazole prophylaxis might be harmful to the immune systems of HIV-exposed, HIV-uninfected infants," Brodie Daniels and Anna Coutsoudis, Principal Investigators, Department of Paediatrics & Child Health, University of KwaZulu-Natal. “With accumulating information on the human microbiome and its effects on immune development and health overall, we need to consider the impact on HIV-exposed, HIV-uninfected infants who are given a daily dose of antibiotics from early infancy. Keeping these infants on prophylaxis without any clear health benefits, while potentially affecting this fundamental part of the development of their immunity, is questionable.”

The WHO recommendation flows from an earlier period when infants were not easily tested for HIV and mothers had poor access to antiretroviral treatment.

If the recommendation is updated for those fully breastfed HEU infants whose mothers participate in transmission prevention programs and live in areas unaffected by malaria, it could help to:

• Reduce inappropriate antibiotic use in children, thus preventing a potentially negative impact on these infants’ microbiomes and consequently on their health
• Help decrease the acceleration of antibiotic resistance
• Save valuable resources required to buy, store and distribute antibiotics
• Eliminate penalties imposed on communities for nonadherence, stemming from logistical or financial roadblocks

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