Azithromycin as a single dose for babies in Africa – a measure to prevent death?

Introduction – the authors start by describing a previous article that studied the use of a single dose of azithromycin twice a year, for 2 consecutive years, in children under the age of 5 in African countries, where the mortality rates of children is high.
The medication was administered to all the children in an entire community on the same day, and the study found a reduction in death rates, especially in infants under the age of 1 year.
As a result, the WHO (World Health Organization) recommends this antibiotic regime to countries that are at risk of high childhood death rates.
So far, so good.
The current study attempted to go one step further by examining whether a single dose of azithromycin to all infants under the age of six months in one community, will bring about similar results, regardless of the timing of administration.
Or in other words, if at one of the routine visits to the well-baby clinic in certain places in the world, a single dose of azithromycin should be administered.

What is azithromycin and why would it prevent death in babies?

Azithromycin is an antibiotic belonging to the macrolide family of antibiotics, that serves us against many different infections, both in developed countries and in countries that are not so developed.

Choosing azithromycin, both in the previous study and in this current one, stems from the idea that there are a number of pathogens that are very common in underdeveloped countries and several of them are sensitive to this antibiotic.

Maybe a single of dose of azithromycin could destroy those pathogens, even before they cause illness in the child, and by doing so, prevent morbidity and death?

And if we are able to prove that administering a single dose, for example to babies visiting to receive their polio or tetanus vaccine in certain countries in Africa, reduces morbidity and mortality, it will be a lot easier to implement this regime in comparison to the current WHO recommendation that requires the administration to occur on the same day for entire populations (communities, villages, etc.).

Methods – the study took place in Burkina Faso, a country in west Africa. In this area, a large percentage of the population show up to their first vaccine appointment, and therefore this is the ideal set-up for leading such a study.
The children received the medication (or placebo, as we will see below) during their visit for vaccine between ages 5-12 weeks.
The dose was 20mg/kg, as a single administration (this is higher than the dose commonly used), and half the children received placebo. Nobody (neither the person administering the medication, the researcher or the parent) knew whether the child was receiving the medication or placebo.
The main outcome assessed was death, for any reason, in the babies before they turned 6 months. Secondary outcomes included hospitalization or visits to the clinic.

Results – over 16,000 children were recruited to each of the two groups. A very large and impressive number. The groups were not different in terms of their starting parameters including age and sex.
As for death rates under the age of 6 months – about 0.5% of the babies died before they turned 6 months, and there was no statistically significant difference between the rates among the two groups.
As for the secondary outcomes – there was no statistically significant difference between the two groups in terms of hospitalization or seeking of medical attention.
At the same time, the drug did not have any significant side effects.

Discussion – okay, this is quite an amazing study. Therefore, even if the results did not demonstrate any advantage to administering of a single dose of antibiotic, the results still bring us to a better understanding of the previous study, that did lead to a reduction in death rates. It seems that treating an individual is not a good strategy, rather it is better to continue to treat large communities on the same day, in order to see a reduction in death rates.

In my opinion these studies, that sometimes produce positive results and at other times don’t, make this world a better place.
The last thing I would like to emphasize is that in Burkina Faso, 1 in 200 babies who come to get vaccinated between the age of 5-12 weeks, will not live to their 6-months birthday.
So, we should be grateful for the good medical services that our children and babies receive.
And we shall hope for a better world, with or regardless of antibiotics.