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In Brief | Infectious Diseases,Vaccines & Antimicrobials

Impact of Azithromycin distribution on childhood mortality in sub-Saharan Africa

Time to read: 01:15 minutes 
Time to listen: 02:47 minutes
 
Published on MedED:  9 October 2024
Originally Published: 21 August 2024
Sourced: NEJM
Type of article: In Brief
MedED Catalogue Reference: MPIB0014
Category: Paediatrics & Neonatology
Cross Reference: Neurology
Keywords: paediatrics, antimicrobials, azithromycin, mortality
 
Key Takeaway
The findings of this study suggest that distributing azithromycin to children aged 1 to 59 months is more effective at reducing mortality than limiting treatment to infants. 

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Originally published in NEJM 21 August 2024
 


The MORDOR trial demonstrated that biannual azithromycin distribution to children aged 1-59 months reduced child mortality in Sub-Saharan Africa.1
 
In response, the World Health Organization suggested limiting this intervention to infants aged 1 to 11 months, aiming to reduce antimicrobial resistance by limiting antibiotic use to the highest-risk group. However, the efficacy of this restricted approach has not been tested.
 
In this study, conducted in rural Niger, communities were randomly assigned to one of three groups: azithromycin for children aged 1 to 59 months (child azithromycin group,) azithromycin for infants aged 1 to 11 months  (infant azithromycin group) with placebo for older children (12-54 months), or placebo for all children aged 1 to 59 months. 
 
Census workers, blinded to group assignments, monitored mortality rates twice yearly over two years. 
 
The primary outcomes assessed were mortality rates (deaths per 1,000 person-years) for different age groups and pairwise comparisons between the groups.
 
The following were recorded:
 
382,586 children from 1,273 communities participated in the study:
 
• There was a 14% decrease in mortality in the child azithromycin group, reporting 11.9 deaths per 1,000 person-years compared to 13.9 in the placebo group
 
• In contrast, the infant azithromycin group showed only a 6% decrease in mortality (22.3 deaths per 1,000 person-years) compared to the placebo group (23.9 deaths per 1,000 person-years)
 
Overall, the findings suggest that distributing azithromycin to children aged 1 to 59 months is more effective at reducing mortality than limiting treatment to infants. 
Ongoing monitoring for antimicrobial resistance is essential. 
 
This study was funded by the Bill and Melinda Gates Foundation and registered under ClinicalTrials.gov (NCT04224987).
 

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