Background: Sub-Saharan Africa remains the region with the highest child mortality rate in the world. Most commonly, pneumonia, diarrhea, and malaria rank among the leading causes of preventable deaths in this population. The World Health Organization (WHO) recommends mass drug administration (MDA) of azithromycin, a broadspectrum macrolide antibiotic, for the treatment of trachoma. Some studies suggest that MDA of azithromycin for this purpose has the added benefit of protection against other illnesses including malaria, diarrheal episodes, and respiratory infections. The aim of this review is to investigate the effect of MDA of azithromycin on mortality rates in African children.
Methods: An exhaustive search of available medical literature was performed using MEDLINE-Ovid, CINHAL, and Web of Science databases. Relevant search terms included ‘azithromycin,’ ‘child*,’ ‘mortality,’ and ‘mass.’ The quality of relevant articles was assessed using the GRADE Working Group guidelines.
Results: A total of 3 studies, 2 randomized control trials (RCT) and 1 observational analysis, were included in this review. One RCT conducted in Malawi, Niger, and Tanzania showed that all-cause mortality rates declined in children ages 1-59 months after azithromycin administration, with the greatest benefit seen in children ages 1-5 months. Another RCT revealed similar findings, with decreased all-cause mortality rates in children ages 1-9 years in Ethiopia after MDA of azithromycin. A retrospective observational analysis also suggested reduced all-cause and infectious mortality rates in children ages 1-5 years in Ethiopia after azithromycin treatment.
Conclusion: MDA of azithromycin in African communities decreases all-cause mortality rates in children ages 1-5 years. Additional studies are needed to assess short and long-term adverse outcomes of MDA and the effect of MDA on antibiotic resistance.
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