1921
Volume 100, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Mass drug administration (MDA) with azithromycin may reduce under-5 child mortality (U5M) in sub-Saharan Africa. Here, we conducted a pooled analysis of all published cluster-randomized trials evaluating the effect of azithromycin MDA on child mortality. We pooled data from cluster-randomized trials randomizing communities to azithromycin MDA versus control. We calculated mortality rates in the azithromycin and control arms in each study, and by country for multisite studies including multiple countries. We conducted a two-stage individual community data meta-analysis to estimate the effect of azithromycin for prevention of child mortality. Three randomized controlled trials in four countries (Ethiopia, Malawi, Niger, and Tanzania) were identified. The overall pooled mortality rate was 15.9 per 1,000 person-years (95% confidence interval [CI]: 15.5–16.3). The pooled mortality rate was lower in azithromycin-treated communities than in placebo-treated communities (14.7 deaths per 1,000 person-years, 95% CI: 14.2–15.3 versus 17.2 deaths per 1,000 person-years, 95% CI: 16.5–17.8). There was a 14.4% reduction in all-cause child mortality in communities receiving azithromycin MDA (95% CI: 6.3–21.7% reduction, = 0.0007). All-cause U5M was lower in communities receiving azithromycin MDA than in control communities, suggesting that azithromycin MDA could be a new tool to reduce child mortality in sub-Saharan Africa. However, heterogeneity in effect estimates suggests that the magnitude of the effect may vary in time and space and is currently not predictable.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0846
2019-01-02
2019-11-13
Loading full text...

Full text loading...

/deliver/fulltext/14761645/100/3/tpmd180846.html?itemId=/content/journals/10.4269/ajtmh.18-0846&mimeType=html&fmt=ahah

References

  1. Emerson PM, Hooper PJ, Sarah V, , 2017. Progress and projections in the program to eliminate trachoma. PLoS Negl Trop Dis 11: e0005402. [Google Scholar]
  2. Solomon AW, 2004. Mass treatment with single-dose azithromycin for trachoma. N Engl J Med 351: 19621971. [Google Scholar]
  3. Chidambaram JD, 2006. Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma. JAMA 295: 11421146. [Google Scholar]
  4. Gaynor BD, 2014. Impact of mass azithromycin distribution on malaria parasitemia during the low-transmission season in Niger: a cluster-randomized trial. Am J Trop Med Hyg 90: 846851. [Google Scholar]
  5. Schachterle SE, Mtove G, Levens JP, Clemens E, Shi L, Raj A, Dumler S, Munoz B, West S, Sullivan DJ, , 2014. Short-term malaria reduction by single-dose azithromycin during mass drug administration for trachoma, Tanzania. Emerg Infect Dis 20: 941949. [Google Scholar]
  6. Fry AM, Jha HC, Lietman TM, Chaudhary JS, Bhatta RC, Elliott J, Hyde T, Schuchat A, Gaynor B, Dowell SF, , 2002. Adverse and beneficial secondary effects of mass treatment with azithromycin to eliminate blindness due to trachoma in Nepal. Clin Infect Dis 35: 395402. [Google Scholar]
  7. Coles CL, Seidman JC, Levens J, Mkocha H, Munoz B, West S, , 2011. Association of mass treatment with azithromycin in trachoma-endemic communities with short-term reduced risk of diarrhea in young children. Am J Trop Med Hyg 85: 691696. [Google Scholar]
  8. Amza A, 2014. Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial. PLoS Negl Trop Dis 8: e3128. [Google Scholar]
  9. Amza A, 2013. A cluster-randomized controlled trial evaluating the effects of mass azithromycin treatment on growth and nutrition in Niger. Am J Trop Med Hyg 88: 138143. [Google Scholar]
  10. Burr SE, Hart J, Edwards T, Harding-Esch EM, Holland MJ, Mabey DC, Sillah A, Bailey RL, , 2014. Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control. BMC Public Health 14: 1176. [Google Scholar]
  11. Porco TC, 2009. Effect of mass distribution of azithromycin for trachoma control on overall mortality in Ethiopian children: a randomized trial. JAMA 302: 962968. [Google Scholar]
  12. Keenan JD, 2018. Mass azithromycin distribution for reducing childhood mortality in sub-Saharan Africa. N Engl J Med 378: 15831592. [Google Scholar]
  13. Gebre T, 2012. Comparison of annual versus twice-yearly mass azithromycin treatment for hyperendemic trachoma in Ethiopia: a cluster-randomised trial. Lancet 379: 143151. [Google Scholar]
  14. Amza A, 2017. A cluster-randomized trial to assess the efficacy of targeting trachoma treatment to children. Clin Infect Dis 64: 743750. [Google Scholar]
  15. Amza A, 2018. Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial. Br J Ophthalmol 102: 680686. [Google Scholar]
  16. O’Brien KS, 2018. Childhood mortality after mass distribution of azithromycin. Pediatr Infect Dis J 37: 10821086. [Google Scholar]
  17. Yusuf S, Collins R, Peto R, , 1984. Why do we need some large, simple randomized trials? Stat Med 3: 409420. [Google Scholar]
  18. Golding N, 2017. Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the sustainable development goals. Lancet 390: 21712182. [Google Scholar]
  19. Skalet AH, 2010. Antibiotic selection pressure and macrolide resistance in nasopharyngeal Streptococcus pneumoniae: a cluster-randomized clinical trial. PLoS Med 7: e1000377. [Google Scholar]
  20. Haug S, 2010. The decline of pneumococcal resistance after cessation of mass antibiotic distributions for trachoma. Clin Infect Dis 51: 571574. [Google Scholar]
  21. Coles CL, Mabula K, Seidman JC, Levens J, Mkocha H, Munoz B, Mfinanga SG, West S, , 2013. Mass distribution of azithromycin for trachoma control is associated with increased risk of azithromycin-resistant Streptococcus pneumoniae carriage in young children 6 months after treatment. Clin Infect Dis 56: 15191526. [Google Scholar]
  22. Leach AJ, Shelby-James TM, Mayo M, Gratten M, Laming AC, Currie BJ, Mathews JD, , 1997. A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae. Clin Infect Dis 24: 356362. [Google Scholar]
  23. Bloch EM, West SK, Mabula K, Weaver J, Mrango Z, Munoz B, Lietman TM, Coles C, , 2017. Antibiotic resistance in young children in Kilosa district, Tanzania 4 years after mass distribution of azithromycin for trachoma control. Am J Trop Med Hyg 97: 815818. [Google Scholar]
  24. Seidman JC, Johnson LB, Levens J, Mkocha H, Muñoz B, Silbergeld EK, West SK, Coles CL, , 2016. Longitudinal comparison of antibiotic resistance in diarrheagenic and non-pathogenic Escherichia coli from young Tanzanian children. Front Microbiol 7: 1420. [Google Scholar]
  25. Seidman JC, Coles CL, Silbergeld EK, Levens J, Mkocha H, Johnson LB, Muñoz B, West SK, , 2014. Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for trachoma control. Int J Epidemiol 43: 11051113. [Google Scholar]
  26. International Trachoma Initiative. Frequently Asked Questions. Available at: http://www.trachomacoalition.org/sites/default/files/content/resources/files/zithromax_Final.pdf. Accessed December 12, 2018.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0846
Loading
/content/journals/10.4269/ajtmh.18-0846
Loading

Data & Media loading...

  • Received : 22 Oct 2018
  • Accepted : 12 Dec 2018
  • Published online : 02 Jan 2019

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error