Two Regimens of Azithromycin Prophylaxis against Community‐Acquired Respiratory and Skin/Soft‐Tissue Infections among Military Trainees

Abstract

Epidemics of community-acquired pneumonia (CAP) are a frequent cause of morbidity among Russian military trainees. We evaluated azithromycin prophylaxis against CAP. In 2001-2002, incoming military trainees were randomized to 1 of 3 trial arms by training group: azithromycin, 500 mg per week for 8 weeks (R1); azithromycin, 1500 mg once at enrollment (R2); or no therapy (R3). During the 22 weeks of training, CAP was diagnosed in 20.2% of 678 subjects in the R3 group, 8.6% of 508 subjects in the R1 group, and 10.3% of 507 subjects in the R2 group. Throat carriage cultures revealed that the proportion of Streptococcus pneumoniae isolates with resistance to macrolides correspondingly increased during the study, from 0% (all) to 40% (R1) and 22.6% (R2) by week 20. Azithromycin prophylaxis is effective against CAP in a healthy population of young men at transient high risk of disease; however, azithromycin use must be tempered with the possible concomitant risk of selection for resistant endemic pathogens.

Community-Based Surveillance in the United States of Macrolide-Resistant Pediatric Pharyngeal Group A Streptococci during 3 Respiratory Disease Seasons

“…In Finland, macrolide resistance rates among GAS were shown to be associated with regional consumption of macrolides in previous years [37]. However, even fairly short-term use of azithromycin by military recruits is associated with emergence of macrolide resistance in Streptococcus pneumoniae [38].…”

Respiratory Infections in the U.S. Military: Recent Experience and Control

“…Pneumococcal disease prevention in the military. Military pneumococcal pneumonia outbreaks have been halted by using mass antimicrobial chemoprophylaxis (416,419), mass pneumococcal vaccination (421,468,469), or a combination of both (413)(414)(415)418). The administration of antimicrobials is important, since the response to the pneumococcal vaccine takes at least 7 to 10 days to be effective, while in such outbreaks, an immediate response is needed.…”

Effect of Mass Distribution of Azithromycin for Trachoma Control on Overall Mortality in Ethiopian Children

“…14 Conversely, antibiotics may reduce both respiratory and gastrointestinal infections, and possibly reduce rates of malaria-all of which are major causes of death in children in trachoma-endemic areas such as rural Ethiopia. 10,12,15 Therefore, the effect of oral azithromycin distribution on mortality was assessed in a clusterrandomized trial of trachoma control in Ethiopia.…”