Abstract
Single-dose mass drug administration of azithromycin (AZT) is underway to eliminate trachoma worldwide. Studies in Ethiopia showed a reduction in all-cause childhood deaths after administration. To examine the effect of single-dose AZ MDA on prevalent malaria infections in a large prospective cohort of children and parents in Dodoma Province, Tanzania, we quantified the temporal prevalence of malaria parasitemia by real-time PCR for 6 months after single-dose AZT. In the first month after treatment but not in subsequent months, Plasmodium falciparum infections were reduced by 73% (95% CI 43%-89%) in treatment versus control villages and differences remained significant (p = 0.00497) in multivariate models with village-level random effects. Genetic sequencing of P. falciparum ribosomal L4 protein showed no mutations associated with AZT resistance. AZT mass drug administration caused a transient, 1-month antimalarial effect without selecting for P. falciparum ribosomal L4 resistance mutations in a region with a 10-year history of treating trachoma with this drug.
Highlights
Single-dose mass drug administration of azithromycin (AZT) is underway to eliminate trachoma worldwide
In a cluster randomized trial in The Gambia, AZ mass drug administration (MDA) given in 3 doses (20 mg/kg) 7 days apart reduced malaria rates by half when measured at 1 time point in children 5–14 years of age [9]
We evaluated malaria prevalence in a cohort of 2,053 children and adults in central Tanzania to examine the effect of single dose AZ MDA on prevalent malaria infections
Summary
Single-dose mass drug administration of azithromycin (AZT) is underway to eliminate trachoma worldwide. Genetic sequencing of P. falciparum ribosomal L4 protein showed no mutations associated with AZT resistance. AZT mass drug administration caused a transient, 1-month antimalarial effect without selecting for P. falciparum ribosomal L4 resistance mutations in a region with a 10-year history of treating trachoma with this drug. A 49% reduction in the odds of death (95% CI 29%–90%) was reported for children 1–9 years of age in an AZ MDA treatment group compared with controls in Ethiopia [10,11]. The authors postulated that the AZT/artesunate showed treatment failure because MDA for trachoma in Tanzania could have led to localized Plasmodium spp. resistance to AZT [12]. RESEARCH ribosomal protein L4 (PfRpL4) (PFC10_API0043) (1.) A Cochrane meta-analysis report stated that “azithromycin’s future for the treatment of malaria does not look promising” [13] and cited studies in which AZT, well tolerated, was inferior to tetracycline for malaria prophylaxis [14,15,16,17]
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