What drugs are used for protein-energy malnutrition?

January 8, 2026 •

3 min read

According to the World Health Organization (WHO), over 20 million children worldwide suffer from severe acute malnutrition, necessitating precise medical intervention. While the primary treatment for protein-energy malnutrition (PEM) is nutritional rehabilitation, drugs play a critical supporting role, especially in addressing underlying infections and managing complications.

Quick Summary

This guide details the various medications used in the management of protein-energy malnutrition, including antibiotics for secondary infections, micronutrient supplements to correct deficiencies, and specific drugs for refeeding syndrome or appetite stimulation. It highlights the importance of a multi-faceted medical approach in both adults and children.

Key Points

Antibiotics are essential: Broad-spectrum antibiotics like amoxicillin and gentamicin treat infections often hidden by a suppressed immune system in severe malnutrition.
Electrolyte and micronutrient corrections: Careful supplementation of potassium, magnesium, zinc, and vitamins is critical, especially during the initial stabilization phase.
Manage refeeding syndrome: A fatal complication, refeeding syndrome is prevented by slow reintroduction of nutrients and proactive electrolyte management.
Delay iron supplementation: Iron is typically withheld during the initial phase of treatment to prevent infections from worsening.
Use appetite stimulants cautiously: Drugs like corticosteroids or cannabinoids may be used in specific contexts, such as cancer cachexia, but are not routine for all PEM cases.
Treatment protocol is multi-staged: Medical management proceeds in distinct phases, from initial stabilization and correction of imbalances to later nutritional rehabilitation.
Pharmacokinetics are affected: Malnutrition can change how a body processes drugs, potentially requiring dose modifications.

Antibiotics to Combat Masked Infections

In cases of severe acute protein-energy malnutrition (SAM), the patient's immune system is severely compromised, meaning that signs of infection, such as fever, may be absent even when an infection is present. For this reason, broad-spectrum antibiotics are often administered empirically to prevent or treat serious infections, particularly in hospitalized children. The choice of antibiotic depends on the severity of the malnutrition and local resistance patterns, and should be chosen based on a local assessment of infectious agent prevalence and drug sensitivity.

For uncomplicated SAM, oral amoxicillin is the standard first-line treatment. A 2013 meta-analysis reaffirmed the survival benefits of using amoxicillin in children with SAM.

For complicated SAM requiring inpatient care, intravenous or intramuscular antibiotics are necessary. Regimens often include:

Intravenous/Intramuscular Ampicillin and Gentamicin: A common combination for treating serious systemic infections.
Ceftriaxone: An alternative for severe cases or areas with high antibiotic resistance.
Metronidazole: Used for specific infections like giardiasis, which is prevalent in many malnourished populations, although its routine use is still debated.

Correcting Electrolyte and Micronutrient Deficiencies

Malnutrition invariably leads to deficiencies in vital electrolytes and micronutrients. Correcting these is a critical step in the stabilization phase of treatment to prevent serious complications like refeeding syndrome. Electrolyte solutions like ReSoMal are specially formulated for malnourished patients to correct electrolyte imbalances gradually.

Micronutrient supplementation is also essential:

Zinc: Often given orally to treat deficiency and help heal skin lesions, which are common in conditions like kwashiorkor.
Potassium and Magnesium: Critically low levels of these are common and require careful replenishment, often via the nutritional feeds.
Folic Acid: A supplement that is typically administered on the first day of treatment and continued daily.
Vitamin A: A high-dose supplement is given at admission, with follow-up doses, especially if there are signs of deficiency or a history of measles.
Iron: This should not be given during the initial stabilization phase of treatment, as it can worsen infections. It is introduced later during nutritional rehabilitation.

Managing Refeeding Syndrome

Refeeding syndrome is a potentially fatal complication that can occur when severely malnourished patients are refed too quickly. The shift from a catabolic to an anabolic state leads to fluid and electrolyte shifts, particularly in phosphate, potassium, and magnesium, that can cause serious cardiac, respiratory, and neurological issues. The medical management of this includes:

Careful electrolyte monitoring: Frequent blood tests are necessary to track phosphate, potassium, and magnesium levels.
Gradual reintroduction of nutrients: Starting with low-calorie nutritional support (e.g., F-75 formula) and slowly increasing intake prevents rapid shifts in electrolytes.
Supplementation: Proactive supplementation of phosphate, potassium, and magnesium is crucial.

Appetite Stimulants for Specific Populations

In certain patient populations, such as those with cancer-related cachexia or older adults, appetite stimulants may be used to help increase food intake. These are not standard for all malnutrition cases and are used selectively based on the underlying cause and patient profile. Examples include corticosteroids and cannabinoids.

Comparison of Key Drugs in PEM Management


Drug Type	Primary Indication	Examples	Mechanism in PEM	Key Consideration
Antibiotics	Treat secondary bacterial infections	Amoxicillin, Ampicillin, Gentamicin	Counteracts systemic infections often masked by a suppressed immune system	Use empirically, especially in severe cases, due to blunted immune response
Electrolyte Replacement	Correct life-threatening mineral imbalances	ReSoMal, Potassium/Magnesium supplements	Restores critical electrolyte balance lost during starvation	Careful monitoring is needed to prevent refeeding syndrome
Micronutrient Supplements	Address specific vitamin and mineral deficiencies	Zinc, Vitamin A, Folic Acid	Supports cellular function, immunity, and healing	Iron should be delayed to prevent worsening infections
Appetite Stimulants	Enhance appetite in specific cachexia cases	Corticosteroids, Cannabinoids	Increases appetite and reduces systemic inflammation	Used selectively in advanced cases; not standard PEM treatment

Conclusion: A Multi-faceted Approach

Addressing what drugs are used for protein-energy malnutrition requires understanding that medication is part of a broader, multi-faceted treatment strategy. Nutritional rehabilitation remains the cornerstone of recovery, with pharmacological interventions used to stabilize the patient, treat complications like infection and refeeding syndrome, and correct critical deficiencies. The specific drugs and protocols vary depending on the patient's age, the severity of the condition, and local clinical guidelines. The overarching goal is to safely and gradually guide the patient toward a state of complete nutritional recovery. Medical professionals must carefully monitor patients throughout this process to adapt treatment as the patient's physiological state improves.

For a deeper dive into the clinical management of severe acute malnutrition, consult the detailed guidelines from the World Health Organization: MANAGEMENT OF SEVERE MALNUTRITION.

Frequently Asked Questions

Severely malnourished children have a weakened immune system that may not produce a fever, even with a serious infection. Broad-spectrum antibiotics are given empirically to preemptively treat these potentially fatal, yet masked, infections.

Refeeding syndrome is a dangerous metabolic complication caused by a rapid shift from a starvation state to feeding. Medications and supplements are used to manage it by correcting severe electrolyte shifts, particularly low phosphate, potassium, and magnesium levels.

Iron supplementation is not given during the initial stabilization phase of PEM treatment. It is introduced later, typically once the patient has a good appetite and is gaining weight, to avoid worsening infections.

Appetite stimulants, such as certain corticosteroids, are not part of standard PEM protocols but can be used in specific populations, like elderly patients with cachexia, to help increase food intake.

ReSoMal (Rehydration Solution for Malnutrition) is a specific oral rehydration fluid with a lower sodium and higher potassium concentration compared to standard ORS. It is used for rehydration and electrolyte correction in malnourished children to prevent imbalances.

Malnutrition can alter the way the body processes drugs due to changes in liver and kidney function, as well as reduced protein binding. This can lead to unpredictable drug clearance and potential toxicity, especially for medications with a narrow therapeutic index.

No. While vitamins and minerals are part of the treatment, PEM is a serious medical condition requiring a comprehensive, clinically supervised treatment plan that includes therapeutic feeding, antibiotics, and specific electrolyte management, not just supplements.