Children enrolled in the trial and randomized to azithromycin will receive a 7-day course of oral amoxcillin given in twice-daily doses of 50-100 mg/kg, per the Burkina Faso guidelines for the management of severe acute malnutrition. The first dose will be administered at the time of enrollment and the remaining dose will be administered by the caregiver at home. Enrolled children will also receive RUTF.

Summarize the cumulative proportion recovered by arm. Children are considered recovered if they had mean upper arm circumference > 12.5 or weight-for-height/length > -2 for 2 consecutive measurements. Additionally, it includes children who had had mean upper arm circumference >12.5 or weight-for-height/length > -2 on their final measurement, regardless of whether they met these criteria on the previous visit.

Rapid diagnostic tests for malaria will be conducted at baseline and week 8 to determine malaria infection status.

Vital status will be assessed at all follow-up time points and mortality will be defined as death during the study period.

Height or length will be measured at all follow-up time points and height-for-age z-scores will be calculated.

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Stunted is length/height-for-age below the -2 z-score line. Severely stunted is below the -3 z-score line

Mid-upper arm circumference will be measured at all follow-up time points

Weight will be measured at all follow-up time points and weight-for-age z-scores will be calculated.

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Underweight is weight-for-age below the -2 z-score line. Severely underweight is below the -3 z-score line.

Weight and height, assessed at all follow-up time points, will be used to calculate weight-for-height z-scores.

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Overweight is weight-for-length/height above the 2 z-score line. Severely overweight; weight-for-length/height above the 3 z-score line

baseline and 8 week intestinal microbiome will be compared between the 2 arms alpha diversity using inverse Simpson's index and Shannon's index, expressed in effective number.

The Shannon Diversity Index is a quantitative measure that reflects how many different bacterial species there are in a sample. The greater the index, the more diverse the gut microbiota. An index of 0 indicates a community that only has one species. A negative change indicates a decrease in diversity and a positive change indicates an increase in diversity.

The Simpson's Diversity Index is a measure of diversity which takes into account the number of species present, as well as the relative abundance of each species. As species richness and evenness increase, so diversity increases. The value ranges between 0 and 1, where 1 represents infinite diversity and 0, no diversity.

Children in this arm will receive a 7 day course of amoxicillin (standard of care)

Amoxicillin: Children enrolled in the trial and randomized to azithromycin will receive a 7-day course of oral amoxcillin given in twice-daily doses of 50-100 mg/kg, per the Burkina Faso guidelines for the management of severe acute malnutrition. The first dose will be administered at the time of enrollment and the remaining dose will be administered by the caregiver at home. Enrolled children will also receive RUTF.

Total of all reporting groups

Mid-Upper Arm Circumference (MUAC) is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow (olecranon process and the acromium). MUAC is used for the assessment of nutritional status.

MUAC less than 11.5cm is considered as severe malnutrition

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean

The score was calculated using the 2006 World Health Organization's Child Growth Standards:

Stunted is length/height-for-age below the -2 z-score line. Severely stunted is below the -3 z-score line

Nutritional recovery is defined as, depending on admission criteria: weight-for-height/length is equal to or more than -2 Z-score and the child have had no oedema for at least 2 weeks, or the mid-upper-arm circumference is equal to or more than 125 mm and the child have had no oedema for at least 2 weeks.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Stunted is length/height-for-age below the -2 z-score line. Severely stunted is below the -3 z-score line

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Summarize the cumulative proportion recovered by arm. Children are considered recovered if they had mean upper arm circumference > 12.5 or weight-for-height/length > -2 for 2 consecutive measurements. Additionally, it includes children who had had mean upper arm circumference >12.5 or weight-for-height/length > -2 on their final measurement, regardless of whether they met these criteria on the previous visit.

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Rapid diagnostic tests for malaria will be conducted at baseline and week 8 to determine malaria infection status.

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Vital status will be assessed at all follow-up time points and mortality will be defined as death during the study period.

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Height or length will be measured at all follow-up time points and height-for-age z-scores will be calculated.

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Stunted is length/height-for-age below the -2 z-score line. Severely stunted is below the -3 z-score line

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Mid-upper arm circumference will be measured at all follow-up time points

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Weight will be measured at all follow-up time points and weight-for-age z-scores will be calculated.

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Underweight is weight-for-age below the -2 z-score line. Severely underweight is below the -3 z-score line.

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

Weight and height, assessed at all follow-up time points, will be used to calculate weight-for-height z-scores.

A z-score of 0 represents the population mean. The z-score will be positive if the data value lies above the mean, and negative if the data value lies below the mean.

Anthropometric outcomes were defined according to the 2006 World Health Organization's Child Growth Standards:

Overweight is weight-for-length/height above the 2 z-score line. Severely overweight; weight-for-length/height above the 3 z-score line

All children who were followed up to 8 weeks. This analysis excludes 19 children who were lost to follow-up before 8 weeks.

baseline and 8 week intestinal microbiome will be compared between the 2 arms alpha diversity using inverse Simpson's index and Shannon's index, expressed in effective number.

The Shannon Diversity Index is a quantitative measure that reflects how many different bacterial species there are in a sample. The greater the index, the more diverse the gut microbiota. An index of 0 indicates a community that only has one species. A negative change indicates a decrease in diversity and a positive change indicates an increase in diversity.

The Simpson's Diversity Index is a measure of diversity which takes into account the number of species present, as well as the relative abundance of each species. As species richness and evenness increase, so diversity increases. The value ranges between 0 and 1, where 1 represents infinite diversity and 0, no diversity.

Children who had a rectal swab collected at baseline and at 8 weeks.

Children in this arm will receive a 7 day course of amoxicillin (standard of care)

Amoxicillin: Children enrolled in the trial and randomized to azithromycin will receive a 7-day course of oral amoxcillin given in twice-daily doses of 50-100 mg/kg, per the Burkina Faso guidelines for the management of severe acute malnutrition. The first dose will be administered at the time of enrollment and the remaining dose will be administered by the caregiver at home. Enrolled children will also receive RUTF.

Sought medical care by 8 weeks

Death by week 8