Effect of amoxicillin on the gut microbiome of children with severe acute malnutrition in Madarounfa, Niger: a retrospective metagenomic analysis of a placebo-controlled trial

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Reviewed Marked as Reviewed by KateRasheed on 2025-8-5
Citation
PMID PubMed identifier for scientific articles.
DOI Digital object identifier for electronic documents.
URI Uniform resource identifier for web resources.
Authors
Schwartz DJ, Langdon A, Sun X, Langendorf C, Berthé F, Grais RF, Trehan I, Isanaka S, Dantas G
Journal
The Lancet. Microbe
Year
2023
BACKGROUND: Children with severe acute malnutrition are treated with antibiotics as outpatients. We aimed to determine the effect of 7 days of amoxicillin on acute and long-term changes to the gut microbiome and antibiotic resistome in children treated for severe acute malnutrition. METHODS: We conducted a secondary analysis of a randomised, double-blinded, placebo-controlled trial (NCT01613547) of amoxicillin in children (aged 6-59 months) with severe acute malnutrition treated as outpatients in Madarounfa, Niger. We randomly selected 161 children from the overall cohort (n=2399) for initial 12-week follow-up from Sept 23, 2013 to Feb 3, 2014. We selected a convenience sample of those 161 children, on the basis of anthropometric measures, for follow-up 2 years later (Sept 28 to Oct 27, 2015). Children provided faecal samples at baseline, week 1, week 4, week 8, week 12, and, for those in the 2-year follow-up cohort, week 104. We conducted metagenomic sequencing followed by microbiome and resistome profiling of faecal samples. 38 children without severe acute malnutrition and six children with severe acute malnutrition matching the baseline ages of the original cohort were used as reference controls. FINDINGS: In the 12-week follow-up group, amoxicillin led to an immediate decrease in gut microbiome richness from 37·6 species (95% CI 32·6-42·7) and Shannon diversity index (SDI) 2·18 (95% CI 1·97-2·39) at baseline to 27·7 species (95% CI 22·9-32·6) species and SDI 1·55 (95% CI 1·35-1·75) at week 1. Amoxicillin increased gut antibiotic resistance gene abundance to 6044 reads per kilobase million (95% CI 4704-7384) at week 1, up from 4800 (3391-6208) at baseline, which returned to baseline 3 weeks later. 35 children were included in the 2-year follow-up; the amoxicillin-treated children (n=22) had increased number of species in the gut microbiome compared with placebo-treated children (n=13; 60·7 [95% CI 54·7-66·6] vs 36·9 [29·4-44·3]). Amoxicillin-treated children had increased Prevotella spp and decreased Bifidobacterium spp relative to age-matched placebo-treated children, indicating a more mature, adult-like microbiome. INTERPRETATION: Amoxicillin treatment led to acute but not sustained increases in antimicrobial resistance genes and improved gut microbiome maturation 2 years after severe acute malnutrition treatment. FUNDING: Bill & Melinda Gates Foundation; Médecins sans Frontières Operational Center Paris; National Institute of Allergy and Infectious Diseases; National Institute of General Medical Sciences; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Edward Mallinckrodt Jr Foundation; Doris Duke Foundation.

Experiment 1


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/05/07

Curator: MyleeeA

Revision editor(s): MyleeeA, Anne-mariesharp

Subjects

Location of subjects
Niger
Host species Species from which microbiome was sampled. Contact us to have more species added.
Homo sapiens
Body site Anatomical site where microbial samples were extracted from according to the Uber Anatomy Ontology
Feces Cow dung,Cow pat,Droppings,Dung,Excrement,Excreta,Faeces,Fecal material,Fecal matter,Fewmet,Frass,Guano,Matières fécales@fr,Merde@fr,Ordure,Partie de la merde@fr,Piece of shit,Porción de mierda@es,Portion of dung,Portion of excrement,Portion of faeces,Portion of fecal material,Portion of fecal matter,Portion of feces,Portion of guano,Portion of scat,Portionem cacas,Scat,Spoor,Spraint,Stool,Teil der fäkalien@de,Feces,feces
Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Treatment Treatment,treatment
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Amoxicillin Week 0
Group 1 name Corresponds to the case (exposed) group for case-control studies
Amoxicillin Week 1
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Children with severe acute malnutrition who received amoxicillin for one week and had their fecal samples collected at the end of treatment (Week 1).
Group 0 sample size Number of subjects in the control (unexposed) group
35
Group 1 sample size Number of subjects in the case (exposed) group
39

Lab analysis

Sequencing type
WMS
16S variable region One or more hypervariable region(s) of the bacterial 16S gene
Not specified
Sequencing platform Manufacturer and experimental platform used for quantifying microbial abundance
Illumina

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
relative abundances
Statistical test
Mann-Whitney (Wilcoxon)
Significance threshold p-value or FDR threshold used for differential abundance testing (if any)
0.05
MHT correction Have statistical tests be corrected for multiple hypothesis testing (MHT)?
Yes

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
decreased
Richness Number of species
decreased

Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/17

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3E

Description: Significant taxonomic changes at the genus level with Benjamini-Hochberg-corrected q-values.

Abundance in Group 1: increased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Escherichia sp.

Revision editor(s): Anne-mariesharp

Signature 2

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/17

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3A, B, C

Description: Significant taxonomic changes at the genus level with Benjamini-Hochberg-corrected q-values.

Abundance in Group 1: decreased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Bifidobacterium sp.
Holdemanella sp.
Lactobacillus sp.

Revision editor(s): Anne-mariesharp

Experiment 2


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/05/07

Curator: MyleeeA

Revision editor(s): MyleeeA, Anne-mariesharp

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Placebo Week 1
Group 0 sample size Number of subjects in the control (unexposed) group
33

Lab analysis

Statistical Analysis

Matched on Factors on which subjects have been matched on in a case-control study
age

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
unchanged
Richness Number of species
unchanged

Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/17

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3E

Description: Significant taxonomic changes at the genus level with Benjamini-Hochberg-corrected q-values.

Abundance in Group 1: increased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Escherichia sp.

Revision editor(s): Anne-mariesharp

Signature 2

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/17

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3A, B

Description: Significant taxonomic changes at the genus level with Benjamini-Hochberg-corrected q-values.

Abundance in Group 1: decreased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Holdemanella sp.
Lactobacillus sp.

Revision editor(s): Anne-mariesharp

Experiment 3


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/05/07

Curator: MyleeeA

Revision editor(s): MyleeeA, Anne-mariesharp

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Placebo Week 0
Group 1 name Corresponds to the case (exposed) group for case-control studies
Placebo Week 1
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Children with severe acute malnutrition who received Placebo for one week and had their fecal samples collected at week 1
Group 0 sample size Number of subjects in the control (unexposed) group
32
Group 1 sample size Number of subjects in the case (exposed) group
33

Lab analysis

Statistical Analysis

Matched on Factors on which subjects have been matched on in a case-control study
Not specified

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
unchanged
Richness Number of species
unchanged

Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/18

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3D

Description: Significant taxonomic changes at the genus level with Benjamini-Hochberg-corrected q-values.

Abundance in Group 1: decreased abundance in Placebo Week 1

NCBI Quality ControlLinks
Klebsiella sp.

Revision editor(s): Anne-mariesharp

Experiment 4


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/05/07

Curator: MyleeeA

Revision editor(s): MyleeeA, Anne-mariesharp

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Placebo Week 1
Group 1 name Corresponds to the case (exposed) group for case-control studies
Amoxicillin Week 1
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Children with severe acute malnutrition who received amoxicillin for one week and had their fecal samples collected at the end of treatment (Week 1).
Group 0 sample size Number of subjects in the control (unexposed) group
33
Group 1 sample size Number of subjects in the case (exposed) group
39

Lab analysis

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
arcsine square-root
Statistical test
MaAsLin2
Matched on Factors on which subjects have been matched on in a case-control study
age

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
unchanged
Richness Number of species
unchanged

Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/18

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3F, Appendix 3 (tab 3)

Description: Coefficients (effect size) and 95% confidence intervals for significant taxonomic enrichment and depletion

Abundance in Group 1: increased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Escherichia sp.

Revision editor(s): Anne-mariesharp

Signature 2

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/18

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3F, Appendix 3 (tab 3)

Description: Coefficients (effect size) and 95% confidence intervals for significant taxonomic enrichment and depletion

Abundance in Group 1: decreased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Dorea sp.
Holdemanella sp.
Lactobacillus sp.
Streptococcus sp.

Revision editor(s): Anne-mariesharp

Experiment 5


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/05/08

Curator: MyleeeA

Revision editor(s): MyleeeA, Anne-mariesharp

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Amoxicillin Week 0
Group 0 sample size Number of subjects in the control (unexposed) group
35

Lab analysis

Statistical Analysis

Matched on Factors on which subjects have been matched on in a case-control study
Not specified

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
decreased
Richness Number of species
decreased

Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/18

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3F, Appendix 3 (tab 3)

Description: Coefficients (effect size) and 95% confidence intervals for significant taxonomic enrichment and depletion

Abundance in Group 1: increased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Escherichia sp.
Klebsiella sp.

Revision editor(s): Anne-mariesharp

Signature 2

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/18

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 3F, Appendix 3 (tab 3)

Description: Coefficients (effect size) and 95% confidence intervals for significant taxonomic enrichment and depletion

Abundance in Group 1: decreased abundance in Amoxicillin Week 1

NCBI Quality ControlLinks
Bifidobacterium sp.
Holdemanella sp.
Lactobacillus sp.

Revision editor(s): Anne-mariesharp

Experiment 6


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/21

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Placebo-treated children (Week 104)
Group 1 name Corresponds to the case (exposed) group for case-control studies
Amoxicillin-treated children (Week 104)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Children with severe acute malnutrition who received amoxicillin for one week, and had their fecal samples collected at the 2-year follow-up (Week 104).
Group 0 sample size Number of subjects in the control (unexposed) group
13
Group 1 sample size Number of subjects in the case (exposed) group
22

Lab analysis

Statistical Analysis

Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/21

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 5C, Appendix 3 (tab 10)

Description: Coefficients (effect size) and 95% CI for taxa significantly different between amoxicillin-treated and placebo-treated children

Abundance in Group 1: increased abundance in Amoxicillin-treated children (Week 104)

NCBI Quality ControlLinks
Catenibacterium mitsuokai
Fusicatenibacter saccharivorans
Gemmiger formicilis
Holdemanella biformis
Leyella stercorea
Ligilactobacillus animalis
Prevotella sp. 885
Schaalia odontolytica
Slackia isoflavoniconvertens
Streptococcus macedonicus
Weissella cibaria
Weissella confusa

Revision editor(s): Anne-mariesharp

Signature 2

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/21

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Figure 5C, Appendix 3 (tab 10)

Description: Coefficients (effect size) and 95% CI for taxa significantly different between amoxicillin-treated and placebo-treated children

Abundance in Group 1: decreased abundance in Amoxicillin-treated children (Week 104)

NCBI Quality ControlLinks
Bifidobacterium bifidum
Bifidobacterium longum

Revision editor(s): Anne-mariesharp

Experiment 7


Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/22

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
non-SAM (Severe Acute Malnutrition) Week 104
Group 1 name Corresponds to the case (exposed) group for case-control studies
SAM (Severe Acute Malnutrition) Placebo at Week 104
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Children with severe acute malnutrition who received placebo for one week, and had their fecal samples collected at the 2-year follow-up (Week 104).
Group 0 sample size Number of subjects in the control (unexposed) group
6
Group 1 sample size Number of subjects in the case (exposed) group
13

Lab analysis

Statistical Analysis

Confounders controlled for Confounding factors that have been accounted for by stratification or model adjustment
age, Confounders controlled for: "anthropometry" is not in the list (abnormal glucose tolerance, acetaldehyde, acute graft vs. host disease, acute lymphoblastic leukemia, acute myeloid leukemia, adenoma, age, AIDS, alcohol consumption measurement, alcohol drinking, ...) of allowed values.anthropometry


Signature 1

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/22

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Supplementary Figure 5, Appendix 3 (tab15)

Description: Coefficient of significantly increased species between placebo-treated and non-SAM children

Abundance in Group 1: increased abundance in SAM (Severe Acute Malnutrition) Placebo at Week 104

NCBI Quality ControlLinks
Bifidobacterium bifidum
Bifidobacterium breve
Bifidobacterium longum

Revision editor(s): Anne-mariesharp

Signature 2

Reviewed Marked as Reviewed by KateRasheed on 2025-8-5

Curated date: 2025/07/22

Curator: Anne-mariesharp

Revision editor(s): Anne-mariesharp

Source: Supplementary Figure 5, Appendix 3 (tab15)

Description: Coefficient of significantly increased species between placebo-treated and non-SAM children

Abundance in Group 1: decreased abundance in SAM (Severe Acute Malnutrition) Placebo at Week 104

NCBI Quality ControlLinks
Faecalibacterium prausnitzii
Prevotella sp. 885
Segatella copri
Prevotella sp. AM42-24

Revision editor(s): Anne-mariesharp