Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa

New England Journal of Medicine
April 26, 2018  Vol. 378 No. 17

Original Article
Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa
Jeremy D. Keenan, M.D., M.P.H., Robin L. Bailey, M.D., Sheila K. West, Ph.D., Ahmed M. Arzika, M.S., John Hart, M.D., Jerusha Weaver, M.P.H., Khumbo Kalua, M.B., B.S., M.Med., Ph.D., Zakayo Mrango, M.D., M.P.H., Kathryn J. Ray, M.S., Catherine Cook, M.P.H., Elodie Lebas, R.N.,
Kieran S. O’Brien, M.P.H., Paul M. Emerson, Ph.D., Travis C. Porco, Ph.D., M.P.H., and Thomas M. Lietman, M.D. for the MORDOR Study Group*
We hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations.
In this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses.
Among postneonatal, preschool children in sub-Saharan Africa, childhood mortality was lower in communities randomly assigned to mass distribution of azithromycin than in those assigned to placebo, with the largest effect seen in Niger. Any implementation of a policy of mass distribution would need to strongly consider the potential effect of such a strategy on antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation; MORDOR number, NCT02047981.)