{ "schema_version": 1, "kind": "condition", "id": "kwashiorkor", "name": "Kwashiorkor (oedematous protein malnutrition)", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD74.00 - condition scope only, no dose · Kwashiorkor(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK507876/ · WHO Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children (NCBI Bookshelf NBK190317) - https://www.ncbi.nlm.nih.gov/books/NBK190317/ · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, p338)", "review_status": "reviewed", "verified_against": "Kwashiorkor (oedematous protein malnutrition) - disease-level clinical article (kwashiorkor-clinical.txt) · WHO Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children (NCBI Bookshelf NBK190317) - https://www.ncbi.nlm.nih.gov/books/NBK190317/ · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, p338)", "verified_date": "2026-08", "treatments": [ { "id": 1056, "generic": "Amoxicillin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "Not applicable - the protocol is for a child (see the paediatric dose)", "adult_duration": "Not applicable", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, p338)", "rationale": "Kwashiorkor is severe acute malnutrition with oedema and is treated on the same WHO protocol. WHO recommendation 3.1 states that children with uncomplicated severe acute malnutrition managed as outpatients should be given a course of oral antibiotic such as amoxicillin, and names no amount. The amount here is the Egyptian formulary's general paediatric dose for a child over 3 months.", "cautions": [ "OEDEMA MAKES THE WEIGHT LIE. The child's measured weight includes the oedema fluid, so a milligram-per-kilogram dose worked from it is an overestimate, and the weight-for-height ratio can look falsely normal. Dose against the programme's assessment, not the scale alone.", "WHO CALLS THE ANTIBIOTIC A CONDITIONAL RECOMMENDATION ON LOW-QUALITY EVIDENCE, and its own wording is \"a course of oral antibiotic such as amoxicillin\" - the drug is an example, not a mandate.", "THIS IS FOR UNCOMPLICATED DISEASE MANAGED AT HOME. Shock, hypoglycaemia, hypothermia, inability to feed or a serious infection means admission, and the antibiotic is then the ward's choice.", "THE AMOUNT IS NOT WHO'S. WHO names amoxicillin without a dose; the trial it summarises used 80 to 90 mg/kg/day for one week, which is the trial's figure. The dose above is the Egyptian formulary's.", "WHO RECORDS THE ARGUMENT AGAINST IT TOO - the article calls routine antibiotic use in this setting controversial, because of resistance and the effect on the gut microbiome.", "Do not give in serious hypersensitivity to amoxicillin or another beta-lactam." ], "peds_mgkg_low": 20.0, "peds_mgkg_high": 40.0, "peds_max_mg": 1500.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Formulary dose, oral, child over 3 months: 20 to 40 mg/kg/day in divided doses every 8 hours, maximum 500 mg per dose, or 25 to 45 mg/kg/day every 12 hours, maximum 875 mg per dose. Infant of 3 months or under: 30 mg/kg/day divided into 2 doses.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 200, "high_mg": 400, "capped": false }, { "weight_kg": 20, "low_mg": 400, "high_mg": 800, "capped": false }, { "weight_kg": 30, "low_mg": 600, "high_mg": 1200, "capped": false }, { "weight_kg": 40, "low_mg": 800, "high_mg": 1500, "capped": true } ], "brands": [ { "trade_name": "AMOXYCILLIN 500MG 10 CAPS B.P.2013", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 6.5, "pack_count": 10, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXICILLIN 500MG 12 CAPS. USP 28", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 8.1, "pack_count": 12, "unit_price": 0.67, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXIL 500MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 9.0, "pack_count": 12, "unit_price": 0.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXICID 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 9.5, "pack_count": 12, "unit_price": 0.79, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "E-MOX 500 MG 16 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 15.6, "pack_count": 16, "unit_price": 0.97, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HICONCIL 500MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.6, "pack_count": 12, "unit_price": 0.97, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BIOMOX 500MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 19.5, "pack_count": 12, "unit_price": 1.62, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBIAMOX 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 45.0, "pack_count": 12, "unit_price": 3.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HICILLIN 125MG/5ML SUSP. 80ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 3.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXIL FORT 250MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 5.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "kwashiorkor" }, { "id": 1058, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Severe protein-energy malnutrition is now rare in Egypt outside extreme poverty or chronic illness, but the GP must recognise it and refer for supervised nutritional rehabilitation.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Severe protein-energy malnutrition is now rare in Egypt outside extreme poverty or chronic illness, but the GP must recognise it and refer for supervised nutritional rehabilitation.", "cautions": [ "RED FLAG - Severe underlying systemic infection or septicaemia presenting without typical fever due to impaired immune response: assess urgently and refer.", "RED FLAG - Severe hypothermia (rectal temperature <35.5 C) or profound hypoglycaemia: assess urgently and refer.", "Oedema, growth failure, and skin/hair changes in a malnourished child require urgent paediatric or nutrition referral; refeeding must be supervised to avoid refeeding syndrome.", "Rare in Egyptian primary care.", "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.", "RED FLAG - There is a risk of refeeding syndrome when reintroducing nutrition rapidly." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "kwashiorkor" }, { "id": 1057, "generic": "Vitamin A", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": null, "adult_dose": "Not applicable - the protocol is for a child (see the paediatric dose)", "adult_duration": "Throughout the treatment period", "dose_source": "WHO Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children (NCBI Bookshelf NBK190317) - https://www.ncbi.nlm.nih.gov/books/NBK190317/", "rationale": "WHO recommendation 4.1 states that children with severe acute malnutrition should receive the daily recommended nutrient intake of vitamin A throughout the treatment period, about 5000 IU daily. Kwashiorkor is severe acute malnutrition, so the recommendation covers it.", "cautions": [ "A CHILD ALREADY ON F-75, F-100 OR PROPER RUTF NEEDS NO SEPARATE VITAMIN A. WHO recommendation 4.2 states the therapeutic food already carries it; adding a high dose on top is how a child is overdosed.", "THE HIGH DOSE IS CONDITIONAL, NOT ROUTINE. WHO recommendation 4.3 gives a single high dose of 50 000 IU, 100 000 IU or 200 000 IU depending on age, on admission, ONLY where the therapeutic food is not fortified to WHO specifications AND vitamin A is not part of another daily supplement. Separately, the guideline's standing recommendations give a high dose on day 1, day 2 and day 15 or discharge, whatever the food, to a child with eye signs of vitamin A deficiency, and the same to a child with recent measles.", "THE RECOMMENDATION DOES NOT SAY WHICH AGE GETS WHICH HIGH DOSE. It writes \"depending on age\" and states no cut-offs. The only age mapping anywhere in the document is a description of the trials it reviewed - 100 000 IU under 1 year, 200 000 IU at 1 year and over - which is what those studies did, not what WHO instructs. Take the bands from the programme protocol being followed.", "WHAT EGYPT ACTUALLY STOCKS IS A 50 000 IU CAPSULE. One registered single-ingredient vitamin A product is on the register (A-VITON, 50 000 IU); a second is cancelled, and the 10 000 IU softgel below is flagged by the register itself as an unregistered import. There is no 5 000 IU medicine, so the daily amount comes from the therapeutic food or a multi-micronutrient product, not from a vitamin A capsule.", "REFEEDING SYNDROME IS THE DANGER OF TREATING THIS - phosphate, potassium and magnesium shift when feeding restarts, and can cause dysrhythmia, rhabdomyolysis, confusion and sudden death." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "About 5000 IU daily, by mouth, for as long as the treatment lasts - as part of a therapeutic food or a multi-micronutrient preparation, not as a separate high-dose capsule. The guideline states no milligram-per-kilogram rule, so none is printed.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "A-VITON 50.000 I.U. 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VITAMIN A 10 000 IU 100 SOFTGELS (ILLEGAL IMPORT)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PURITANS PRIDE", "price_egp": 63.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "kwashiorkor" } ] }