Strategy of mass distribution of Azithromycin shows Potential in Reducing Childhood Mortality: NEJM

A recent study highlighted a promising intervention to combat childhood mortality in sub-Saharan Africa through the mass distribution of azithromycin. The study was conducted in rural communities in Niger and suggests that twice-yearly distributions of the antibiotic to children between 1 to 59 months old can significantly reduce mortality rates when compared to more limited distribution among infants.

The study has come at a time when childhood mortality remains a critical public health challenge in the region, it was designed to test the efficacy of azithromycin distribution across different age groups. The World Health Organization (WHO) had previously recommended limiting the distribution to infants aged 1 to 11 months to curb the rise of antimicrobial resistance. However, this restriction had not been tested on a large scale, prompting the need for this study.

This randomized trial involved nearly 1,273 communities across Niger. These communities were divided into 3 groups, where one received azithromycin for children aged 1 to 59 months (the child azithromycin group), another received the drug for infants aged 1 to 11 months only (the infant azithromycin group), and a control group received a placebo for children aged 1 to 59 months. The trial spanned for 2 years and the mortality data was carefully monitored.

In the communities where azithromycin was administered to children aged 1 to 59 months, the mortality rates were significantly lower than in the placebo group. Also, there were 11.9 deaths per 1,000 person-years in the child azithromycin group when compared to 13.9 deaths per 1,000 person-years in the placebo group. This represents a 14% reduction in mortality, with a confidence interval of 7% to 22%, which makes it a statistically significant finding.

On the other hand, the results from the infant azithromycin group were less conclusive. The study observed a slight reduction in mortality among infants aged 1 to 11 months, with 22.3 deaths per 1,000 person-years when compared to 23.9 deaths per 1,000 person-years in the placebo group. This reduction translated to a 6% decrease in mortality and was not statistically significant. Thus, this indicated that the impact of azithromycin may be more pronounced in older children.

The study also monitored adverse events, reporting 5 serious cases which was 3 in the placebo group and 1 each in the infant and child azithromycin groups. This suggested that the treatment was generally well-tolerated. Overall, the distribution of azithromycin to children aged 1 to 59 months in Niger significantly reduced mortality rates, proving more effective than limiting the treatment to infants. 

Reference:

O’Brien, K. S., Arzika, A. M., Amza, A., Maliki, R., Aichatou, B., Bello, I. M., Beidi, D., Galo, N., Harouna, N., Karamba, A. M., Mahamadou, S., Abarchi, M., Ibrahim, A., Lebas, E., Peterson, B., Liu, Z., Le, V., Colby, E., Doan, T., … Lietman, T. M. (2024). Azithromycin to Reduce Mortality — An Adaptive Cluster-Randomized Trial. In New England Journal of Medicine (Vol. 391, Issue 8, pp. 699–709). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2312093