Abstract
BackgroundMass azithromycin distributions have been shown to reduce mortality among pre-school children in sub-Saharan Africa. It is unclear what mediates this mortality reduction, but one possibility is that antibiotics function as growth promoters for young children.Methods and findings24 rural Ethiopian communities that had received biannual mass azithromycin distributions over the previous four years were enrolled in a parallel-group, cluster-randomized trial. Communities were randomized in a 1:1 ratio to either continuation of biannual oral azithromycin (20mg/kg for children, 1 g for adults) or to no programmatic antibiotics over the 36 months of the study period. All community members 6 months and older were eligible for the intervention. The primary outcome was ocular chlamydia; height and weight were measured as secondary outcomes on children less than 60 months of age at months 12 and 36. Study participants were not masked; anthropometrists were not informed of the treatment allocation. Anthropometric measurements were collected for 282 children aged 0–36 months at the month 12 assessment and 455 children aged 0–59 months at the month 36 assessment, including 207 children who had measurements at both time points. After adjusting for age and sex, children were slightly but not significantly taller in the biannually treated communities (84.0 cm, 95%CI 83.2–84.8, in the azithromycin-treated communities vs. 83.7 cm, 95%CI 82.9–84.5, in the untreated communities; mean difference 0.31 cm, 95%CI -0.85 to 1.47, P = 0.60). No adverse events were reported.ConclusionsPeriodic mass azithromycin distributions for trachoma did not demonstrate a strong impact on childhood growth.Trial registrationThe TANA II trial was registered on clinicaltrials.gov #NCT01202331.
Highlights
Undernutrition is thought to contribute more to the global burden of disease than any other risk factor.[1]
24 rural Ethiopian communities that had received biannual mass azithromycin distributions over the previous four years were enrolled in a parallel-group, cluster-randomized trial
Periodic mass azithromycin distributions for trachoma did not demonstrate a strong impact on childhood growth
Summary
Undernutrition is thought to contribute more to the global burden of disease than any other risk factor.[1] Poor nutrition potentiates the effects of infections such as diarrhea, respiratory infections, and malaria, leading to worse outcomes and higher mortality.[2, 3] Infectious diseases in turn lead to poor growth.[4] It is conceivable that antibiotics could have an important role for breaking this cycle of malnutrition and infection. A randomized trial demonstrated less stunting and underweight in HIV-infected children who took daily co-trimoxazole compared to those taking placebo.[5] This idea is not new; antibiotics have long been thought to be effective growth promoters for animal husbandry.[6]. Mass azithromycin distributions have been shown to reduce mortality among pre-school children in sub-Saharan Africa It is unclear what mediates this mortality reduction, but one possibility is that antibiotics function as growth promoters for young children
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