Effect of Single-dose Azithromycin on Pneumococcal Carriage and Resistance: A Randomized Controlled Trial

Coulibaly, Boubacar; Kiemde, Dramane; Zonou, Guillaume; Sié, Ali; Dah, Clarisse; Bountogo, Mamadou; Brogdon, Jessica; Hu, Hui-Yu; Lebas, Elodie; Porco, Travis C.; Doan, Thuy; Lietman, Thomas M.; Oldenburg, Catherine E.

doi:10.1097/inf.0000000000003585

Cited by 2 publications

(2 citation statements)

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“…Selection for macrolide resistance has been observed in studies of both individual and mass distribution of azithromycin for trachoma and childhood mortality, although any selection for macrolide resistance typically declines after selection pressure is removed. [28][29][30] It is likely that the single dose of azithromycin led to short-term increases in macrolide resistance in the present study; however, any clinical implications of this are unclear. A companion trial to the present work found transient effects of azithromycin on pneumococcal macrolide resistance that returns to baseline levels by 6 months.…”

Section: Discussionmentioning

confidence: 73%

“…A companion trial to the present work found transient effects of azithromycin on pneumococcal macrolide resistance that returns to baseline levels by 6 months. 28 The consequences of transient increases in macrolide resistance in potentially pathogenic organisms are not well characterized. Previous trials of mass azithromycin distribution have not found reductions in efficacy over time, suggesting that any selection for antimicrobial resistance does not reduce efficacy for preventing mortality, and macrolides are rarely used as first-line therapy in the study area.…”

Section: Discussionmentioning

confidence: 99%

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Neonatal Azithromycin Administration and Growth during Infancy: A Randomized Controlled Trial

Sié

Bountogo

Zakané

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Observational studies have linked early-life antibiotic exposure to increased risk of obesity in children in high income settings. We evaluated whether neonatal antibiotic exposure led to changes in infant growth at 6 months of age in Burkina Faso. Neonates aged 8 to 27 days of age who weighed at least 2,500 g at the time of enrollment were randomized in a 1:1 fashion to a single oral 20-mg/kg dose of azithromycin or equivalent volume of placebo from April 2019 through December 2020. Weight, length, and mid-upper-arm circumference (MUAC) were measured at baseline and 6 months of age. Growth outcomes, including weight gain in grams per day, length change in millimeters per day, and changes in weight-for-age Z-score (WAZ), weight-for-length Z-score (WLZ), length-for-age Z-score (LAZ), and MUAC were compared among neonates randomized to azithromycin compared with placebo. Among 21,832 neonates enrolled in the trial, median age at enrollment was 11 days, and 50% were female. We found no evidence of a difference in weight gain (mean difference −0.009 g/day, 95% confidence interval [CI]: −0.16 to 0.14, P = 0.90), length change (mean difference 0.003 mm/day, 95% CI: −0.002 to 0.007, P = 0.23), or WAZ (mean difference −0.005 SD, 95% CI: −0.03 to 0.02, P = 0.72), WLZ (mean difference −0.01 SD, 95% CI: −0.05 to 0.02, P = 0.39), LAZ (mean difference 0.01, 95% CI: −0.02 to 0.04, P = 0.47), or MUAC (mean difference 0.01 cm, 95% CI: −0.02 to 0.04, P = 0.49). These results do not suggest that azithromycin has growth-promoting properties in infants when administered during the neonatal period. Trial registration: ClinicalTrials.gov NCT03682653.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%