Azithromycin versus Amoxicillin and Malarial Parasitemia among Children with Uncomplicated Severe Acute Malnutrition: A Randomized Controlled Trial

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  • 1 Centre de Recherche en Santé de Nouna, Burkina Faso;
  • | 2 Centre de Recherche et Interventions en Santé Publique, Niamey, Niger;
  • | 3 Francis I Proctor Foundation, University of California, San Francisco, California;
  • | 4 Department of Ophthalmology, University of California, San Francisco, California;
  • | 5 Department of Epidemiology and Biostatistics, University of California, San Francisco, California

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.

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Author Notes

Address correspondence to Catherine E. Oldenburg, Francis I Proctor Foundation, University of California, San Francisco, 490 Illinois St., Floor 2, San Francisco, CA 94143. E-mail:

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 (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:,,,, and Ahmed M. Arzika, The Carter Center, Niamey, Niger, E-mail: 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:,,,, and