World Health Organization , 2010. Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children. Geneva, Switzerland: WHO.
Bourke CD, Berkley JA, Prendergast AJ, 2016. Immune dysfunction as a cause and consequence of malnutrition. Trends Immunol 37: 386–398.
Isanaka S et al., 2016. Routine amoxicillin for uncomplicated severe acute malnutrition in children. N Engl J Med 374: 444–453.
Trehan I et al., 2013. Antibiotics as part of the management of severe acute malnutrition. N Engl J Med 368: 425–435.
Dahl EL, Rosenthal PJ, 2007. Multiple antibiotics exert delayed effects against the Plasmodium falciparum apicoplast. Antimicrob Agents Chemother 51: 3485–3490.
Sidhu ABS, Sun Q, Nkrumah LJ, Dunne MW, Sacchettini JC, Fidock DA, 2007. In vitro efficacy, resistance selection, and structural modeling studies implicate the malarial parasite apicoplast as the target of azithromycin. J Biol Chem 282: 2494–2504.
Arzika AM et al., 2019. Biannual mass azithromycin distributions and malaria parasitemia in pre-school children in Niger: a cluster-randomized, placebo-controlled trial. PLoS Med 16: e1002835.
Keenan JD et al., 2020. Cause-specific mortality of children younger than 5 years in communities receiving biannual mass azithromycin treatment in Niger: verbal autopsy results from a cluster-randomised controlled trial. Lancet Glob Health 8: 288–295.
O’Brien K et al., 2021. Azithromycin for uncomplicated severe acute malnutrition: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 7: 97.
Burki TK, 2013. Malaria and malnutrition: Niger’s twin crises. Lancet 382: 587–588.
Dalrymple U, Arambepola R, Gething PW, Cameron E, 2018. How long do rapid diagnostic tests remain positive after anti-malarial treatment? Malar J 17: 228.
Oldenburg CE, Guerin PJ, Berthé F, Grais RF, Isanaka S, 2018. Malaria and nutritional status among children with severe acute malnutrition in Niger: a prospective cohort study. Clin Infect Dis 67: 1027–1034.
Belesova K, Gasparrini A, Sie A, Sauerborn R, Wilkinson P, 2018. Annual crop yield variation, child survival, and nutrition among subsistence farmers in Burkina Faso. Am J Epidemiol 187: 242–250.
im Kampe EO, Muller O, Sie A, Becher H, 2015. Seasonal and temporal trends in all-cause and malaria mortality in rural Burkina Faso, 1998–2007. Malar J 14: 300.
Das D et al., 2018. Complex interactions between malaria and malnutrition: a systematic literature review. BMC Med 16: 186.
Arzika AM et al., 2020. Malaria parasitemia and nutritional status during the low transmission season in the presence of azithromycin distribution among preschool children in Niger. Am J Trop Med Hyg 103: 1315–1318.
O’Brien KS et al., 2021. Comparing azithromycin to amoxicillin in the management of uncomplicated severe acute malnutrition in Burkina Faso: a pilot randomized trial. medRxiv. Available at: https://doi.org/10.1101/2021.06.15.21258967.
Acquah FK et al., 2021. Diagnostic performance of an ultrasensitive HRP2-based malaria rapid diagnostic test kit used in surveys of afebrile people living in southern Ghana. Malar J 20: 125.
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Antibiotics are recommended by the WHO as part of the management of uncomplicated severe acute malnutrition in children. We evaluated whether azithromycin, an antibiotic with antimalarial properties, improved malarial parasitemia outcomes in children with severe acute malnutrition compared with amoxicillin, an antibiotic commonly used for severe acute malnutrition that does not have antimalarial properties. Total of 301 children were randomized (1:1) to a single oral dose of azithromycin or a 7-day course of amoxicillin and followed for 8 weeks. We found no significant evidence that children receiving azithromycin had improved parasitemia outcomes relative to amoxicillin. Although azithromycin may have advantages over amoxicillin in terms of dosing and administration for uncomplicated severe acute malnutrition, it may not yield additional benefit for malaria outcomes.
Financial support: This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (R21HD100932) and a UCSF REAC award. The funders reviewed the study design and had no role in the conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication. This study is registered with clinicaltrials.gov (NCT03568643, first registered 26 June 2018).
Authors’ addresses: Ali Sié, Clarisse Dah, Millogo Ourohiré, Moussa Ouédraogo, and Valentin Boudo, Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Ahmed M. Arzika, The Carter Center, Niamey, Niger, E-mail: firstname.lastname@example.org. Elodie Lebas, Fanice Nyatigo, Benjamin F. Arnold, Catherine E. Oldenburg, and Kieran S. O’Brien, University of California San Francisco, Francis I. Proctor Foundation, San Francisco, CA, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com.