Study finds, biannual azithromycin administration reduces mortality in children

A new study published in recent issue of The Journal of Antimicrobial Chemotherapy revealed a large biennial distribution of azithromycin dramatically lowers mortality of children aged 1 to 5 in high-mortality regions.

In high-mortality areas, especially sub-Saharan Africa, biannual mass drug administration of azithromycin (MDA-azithromycin) has been suggested as a means of lowering infant mortality. Since MDA programs seem to be one of the most equitable intervention platforms in low-resource contexts, delivery through MDA presents the chance to influence the most underprivileged and marginalized groups. Thus, Meenalotchini Prakash Gurunthalingam and colleagues carried out this investigation to assess the effectiveness of MDA-azithromycin across a range of protocols and conditions.

Through September 2024, following a thorough search of PubMed, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov for randomized controlled studies (RCTs) that compared biennial MDA-azithromycin to placebo in children ages 1 to 59 months. Mortality in children under one year and those aged 12 to 59 months were the main results. Antibiotic resistance and adverse effects were secondary results.

Review Manager 5.4's random-effects model was used to analyze the data, and I2 was used to measure heterogeneity. The Cochrane RoB2 tool evaluated risk of bias, while trial sequential analysis (TSA) evaluated cumulative evidence reliability.

There were nearly 691 to 235 children from 5 RCTs. TSA indicated inconclusive data on azithromycin's non-significant mortality decrease in children under one year of age. MDA-azithromycin dramatically decreased mortality in children aged 12 to 59 months, with TSA confirming adequate evidence.

Although adverse effects were uncommon, there was little information on antibiotic resistance, which called for more observation. One trial had a significant risk of bias, and the quality of the evidence varied from moderate to extremely low.

Overall, as per WHO guidelines, biannual MDA-azithromycin considerably lowers mortality in children aged 12 to 59 months, hence promoting its usage in high-mortality settings.

Reference:

Gurunthalingam, M. P., Singh, M. P., & Gaikwad, N. R. (2025). Biannual azithromycin mass drug administration for reduction of childhood mortality: a systematic review and meta-analysis. The Journal of Antimicrobial Chemotherapy. https://doi.org/10.1093/jac/dkaf092