Abstract
.Reductions in malaria morbidity have been reported following azithromycin mass drug administration (MDA) for trachoma. The recent Macrolides Oraux pour Reduire les Deces avec un Oeil sur la Resistance (MORDOR) trial reported a reduction in child mortality following biannual azithromycin MDA. Here, we investigate the effects of azithromycin MDA on malaria at the MORDOR-Malawi study site. A cluster-randomized double-blind placebo-controlled trial, with 15 clusters per arm, was conducted. House-to-house census was updated biannually, and azithromycin or placebo syrup was distributed to children aged 1–59 months for a total of four biannual distributions. At baseline, 12-month, and 24-month follow-up visits, a random sample of 1,200 children was assessed for malaria with thick and thin blood smears and hemoglobin measurement. In the community-level analysis, there was no difference in the prevalence of parasitemia (1.0% lower in azithromycin-treated communities; 95% CI: −8.2 to 6.1), gametocytemia (0.7% lower in azithromycin-treated communities; 95% CI: −2.8 to 1.5), or anemia (1.7% lower in azithromycin-treated communities; 95% CI: −8.1 to 4.6) between placebo and azithromycin communities. Further interrogation of the data at the individual level, both per-protocol (including only those who received treatment 6 months previously) and by intention-to-treat, did not identify differences in parasitemia between treatment arms. In contrast to several previous reports, this study did not show an effect of azithromycin MDA on malaria parasitemia at the community or individual levels.
Highlights
The Macrolides Oraux pour Reduire les Deces avec un Oeil sur la Resistance (MORDOR) trial, conducted in Niger, Malawi, and Tanzania, demonstrated a reduction in child mortality following biannual mass drug administration (MDA) with azithromycin.[1]
The prevalence of gametocytemia remained similar between treatment groups at the follow-up rounds: 0.7% lower in azithromycintreated communities
Several morbidity sub-studies were nested within the MORDOR trial to investigate mechanisms through which azithromycin MDA may reduce mortality
Summary
The Macrolides Oraux pour Reduire les Deces avec un Oeil sur la Resistance (MORDOR) trial, conducted in Niger, Malawi, and Tanzania, demonstrated a reduction in child mortality following biannual mass drug administration (MDA) with azithromycin.[1]. Azithromycin is a broad spectrum antibiotic with a relatively long half-life which is used in the treatment of pneumonia and diarrhea and displays antimalarial activity.[2,3] Field trials of the effects of azithromycin MDA on malaria infection and symptoms have previously reported reductions in malariometric indices; and recent results from the Niger MORDOR site indicate an association between azithromycin MDA and lower parasitemia.[3,4,5,6,7] It is feasible that the mortality benefit seen with azithromycin MDA may be due, at least in part, to a decrease in malaria prevalence or severity. This study reports malaria parasitemia, parasite density, and gametocytemia data from the MORDOR Malawi study site, aiming to improve our understanding of the effects of azithromycin MDA on malaria infection. The hypothesis for this study was that azithromycin MDA would reduce the community prevalence of malaria compared with placebo
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