Does Mass Azithromycin Distribution Impact Child Growth and Nutrition in Niger? A Cluster-Randomized Trial

Abstract

BackgroundAntibiotic use on animals demonstrates improved growth regardless of whether or not there is clinical evidence of infectious disease. Antibiotics used for trachoma control may play an unintended benefit of improving child growth.MethodologyIn this sub-study of a larger randomized controlled trial, we assess anthropometry of pre-school children in a community-randomized trial of mass oral azithromycin distributions for trachoma in Niger. We measured height, weight, and mid-upper arm circumference (MUAC) in 12 communities randomized to receive annual mass azithromycin treatment of everyone versus 12 communities randomized to receive biannual mass azithromycin treatments for children, 3 years after the initial mass treatment. We collected measurements in 1,034 children aged 6–60 months of age.Principal FindingsWe found no difference in the prevalence of wasting among children in the 12 annually treated communities that received three mass azithromycin distributions compared to the 12 biannually treated communities that received six mass azithromycin distributions (odds ratio = 0.88, 95% confidence interval = 0.53 to 1.49).Conclusions/SignificanceWe were unable to demonstrate a statistically significant difference in stunting, underweight, and low MUAC of pre-school children in communities randomized to annual mass azithromycin treatment or biannual mass azithromycin treatment. The role of antibiotics on child growth and nutrition remains unclear, but larger studies and longitudinal trials may help determine any association.

Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study

“…31,32 The effect of mass azithromycin distribution on nutritional status is less clear. 33,34 In this study population, another secondary analysis indicated that biannual distribution of azithromycin was associated with reduced under-5 mortality compared with annual distribution. 35 Overall, the distribution of oral azithromycin to this population may have affected the prevalence of both nutritional status and malaria in this setting.…”

Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study

“…There is evidence from mass treatment trials for trachoma that macrolide administration reduced all-cause mortality, although it is unclear whether undernutrition mediated this effect [ 42 ]. Estimates from similar trials that compared the frequency of azithromycin administration for trachoma control have suggested some effect of more frequent azithromycin administration on linear growth [ 43 ]. Any observed benefit would have to be weighed against the potential harms of early antibiotic use, in particular selection for drug resistance and collateral effects on the gut microbiota [ 44–46 ].…”

Malaria Parasitemia and Nutritional Status during the Low Transmission Season in the Presence of Azithromycin Distribution among Preschool Children in Niger

“… 17 However, an effect on anthropometric outcomes has not been consistently shown in studies of mass azithromycin distribution for trachoma control. 18 , 19 Azithromycin has some activity against malaria and has been shown in some studies of mass distribution for trachoma to affect parasitemia and splenomegaly. 10 , 12 , 20 In the same study in which communities were measured at the same time points, azithromycin was effective at reducing the burden of malaria parasitemia.…”