Volume 85, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A cohort study was designed to assess the impact of mass distribution of azithromycin (MDA) for trachoma control on incidence over six months of pediatric diarrhea in eight communities in rural Tanzania. A single dose of azithromycin was offered to all residents in four communities, where trachoma prevalence was ≥ 10%. Four geographically matched communities had trachoma prevalences < 10% and did not receive MDA. All randomly selected children (n = 1036) were followed-up for six months post-MDA with bi-weekly surveillance at home. In the 0–1-month and 1–3-month periods, MDA exposure was associated with a 39% (rate ratio = 0.61, 95% confidence interval = 0.39–0.95) and 24% (rate ratio = 0.76, 95% confidence interval = 0.54–1.07) lower risk of diarrhea, respectively, compared with those unexposed, after adjustment for clustering and covariates. By the 3–6-month period, diarrhea incidence was comparable between groups. Thus, MDA was associated with a short-term reduction in diarrheal morbidity in children.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Mariotti SP, Pascolini D, Rose-Nussbaumer J, , 2009. Trachoma: global magnitude of a preventable cause of blindness. Br J Ophthalmol 93: 563568.[Crossref] [Google Scholar]
  2. Wright HR, Turner A, Taylor HR, , 2008. Trachoma. Lancet 371: 19451954.[Crossref] [Google Scholar]
  3. Chidambaram JD, Alemayehu W, Melese M, Lakew T, Yi E, House J, Cevallos V, Zhou Z, Maxey K, Lee DC, Shapiro BL, Srinivasan M, Porco T, Whitcher JP, Gaynor BD, Lietman TM, , 2006. Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma. JAMA 295: 11421146.[Crossref] [Google Scholar]
  4. West SK, Munoz B, Mkocha H, Holland MJ, Aguirre A, Solomon AW, Foster A, Bailey RL, Mabey DC, , 2005. Infection with Chlamydia trachomatis after mass treatment of a trachoma hyperendemic community in Tanzania: a longitudinal study. Lancet 366: 12961300.[Crossref] [Google Scholar]
  5. Solomon AW, Holland MJ, Alexander ND, Massae PA, Aguirre A, Natividad-Sancho A, Molina S, Safari S, Shao JF, Courtright P, Peeling RW, West SK, Bailey RL, Foster A, Mabey DC, , 2004. Mass treatment with single-dose azithromycin for trachoma. N Engl J Med 351: 19621971.[Crossref] [Google Scholar]
  6. Mariotti SP, , 2004. New steps toward eliminating blinding trachoma. N Engl J Med 351: 20042007.[Crossref] [Google Scholar]
  7. Negrel AD, Mariotti SP, , 1998. WHO alliance for the global elimination of blinding trachoma and the potential use of azithromycin. Int J Antimicrob Agents 10: 259262.[Crossref] [Google Scholar]
  8. Diniz-Santos DR, Silva LR, Silva N, , 2006. Antibiotics for the empirical treatment of acute infectious diarrhea in children. Braz J Infect Dis 10: 217227.[Crossref] [Google Scholar]
  9. Carbon C, Poole MD, , 1999. The role of newer macrolides in the treatment of community-acquired respiratory tract infection. A review of experimental and clinical data. J Chemother 11: 107118.[Crossref] [Google Scholar]
  10. DuPont HL, , 2007. Azithromycin for the self-treatment of traveler's diarrhea. Clin Infect Dis 44: 347349.[Crossref] [Google Scholar]
  11. O'Ryan M, Prado V, Pickering LK, , 2005. A millennium update on pediatric diarrheal illness in the developing world. Semin Pediatr Infect Dis 16: 125136.[Crossref] [Google Scholar]
  12. World Health Organization, 2008. The Global Burden of Disease: 2004 update. 16–27. Geneva: World Health Organization, 1627. [Google Scholar]
  13. Lorntz B, Soares AM, Moore SR, Pinkerton R, Gansneder B, Bovbjerg VE, Guyatt H, Lima AM, Guerrant RL, , 2006. Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25: 513520.[Crossref] [Google Scholar]
  14. Niehaus MD, Moore SR, Patrick PD, Derr LL, Lorntz B, Lima AA, Guerrant RL, , 2002. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. Am J Trop Med Hyg 66: 590593. [Google Scholar]
  15. Lanata CF, Mendoza W, , 2002. Improving Diarrhea Estimates. Geneva: World Health Organization. [Google Scholar]
  16. Yates J, , 2005. Traveler's diarrhea. Am Fam Physician 71: 20952100. [Google Scholar]
  17. Khan WA, Seas C, Dhar U, Salam MA, Bennish ML, , 1997. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med 126: 697703.[Crossref] [Google Scholar]
  18. Tribble DR, Sanders JW, Pang LW, Mason C, Pitarangsi C, Baqar S, Armstrong A, Hshieh P, Fox A, Maley EA, Lebron C, Faix DJ, Lawler JV, Nayak G, Lewis M, Bodhidatta L, Scott DA, , 2007. Traveler's diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clin Infect Dis 44: 338346.[Crossref] [Google Scholar]
  19. World Health Organization, 2008. Integrated Management of Childhood Illness. Geneva: World Health Organization. [Google Scholar]
  20. 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.[Crossref] [Google Scholar]
  21. Whitty CJ, Glasgow KW, Sadiq ST, Mabey DC, Bailey R, , 1999. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatr Infect Dis J 18: 955958.[Crossref] [Google Scholar]
  22. Ayyagari A, Agarwal J, Garg A, , 2003. Antibiotic associated diarrhoea: infectious causes. Indian J Med Microbiol 21: 611. [Google Scholar]
  23. Bartlett JG, , 2002. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 346: 334339.[Crossref] [Google Scholar]
  24. Hogenauer C, Hammer HF, Krejs GJ, Reisinger EC, , 1998. Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis 27: 702710.[Crossref] [Google Scholar]
  25. Batt SL, Charalambous BM, Solomon AW, Knirsch C, Massae PA, Safari S, Sam NE, Everett D, Mabey DC, Gillespie SH, , 2003. Impact of azithromycin administration for trachoma control on the carriage of antibiotic-resistant Streptococcus pneumoniae . Antimicrob Agents Chemother 47: 27652769.[Crossref] [Google Scholar]
  26. Gaynor BD, Holbrook KA, Whitcher JP, Holm SO, Jha HC, Chaudhary JS, Bhatta RC, Lietman T, , 2003. Community treatment with azithromycin for trachoma is not associated with antibiotic resistance in Streptococcus pneumoniae at 1 year. Br J Ophthalmol 87: 147148.[Crossref] [Google Scholar]
  27. 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.[Crossref] [Google Scholar]
  28. Haug S, Lakew T, Habtemariam G, Alemayehu W, Cevallos V, Zhou Z, House J, Ray K, Porco T, Rutar T, Keenan J, Lietman TM, Gaynor BD, , 2010. The decline of pneumococcal resistance after cessation of mass antibiotic distributions for trachoma. Clin Infect Dis 51: 571574.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 21 Jan 2011
  • Accepted : 16 Jul 2011
  • Published online : 01 Oct 2011

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