The Duration of Protection from Azithromycin Against Malaria, Acute Respiratory, Gastrointestinal, and Skin Infections When Given Alongside Seasonal Malaria Chemoprevention: Secondary Analyses of Data from a Clinical Trial in Houndé, Burkina Faso, and Bougouni, Mali
| Autor: | Jean-Bosco Ouédraogo, Amadou Tapily, Daniel Chandramohan, Issaka Zongo, Frederic Nikiema, Paul Milligan, Brian Greenwood, Irene Kuepfer, Rakiswendé S. Yerbanga, Mphatso Dennis Phiri, Alassane Dicko, Samba Coumare, Issaka Sagara, Amadou Barry, Matthew Cairns, Modibo Diarra, Ismaila Thera, Halidou Tinto |
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| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Vector-Borne Diseases Collection 030231 tropical medicine Amodiaquine Azithromycin Mali Placebo child mortality Chemoprevention Antimalarials 03 medical and health sciences symbols.namesake 0302 clinical medicine Sahel Internal medicine Burkina Faso medicine Humans 030212 general & internal medicine Poisson regression Online Only Articles duration of protection Mass drug administration business.industry Incidence (epidemiology) Infant medicine.disease seasonal malaria chemoprevention Malaria Clinical trial Drug Combinations AcademicSubjects/MED00290 Infectious Diseases Child Preschool symbols Seasons business medicine.drug |
| Zdroj: | Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciaa1905 |
| Popis: | Background Mass drug administration (MDA) with azithromycin (AZ) is being considered as a strategy to promote child survival in sub-Saharan Africa, but the mechanism by which AZ reduces mortality is unclear. To better understand the nature and extent of protection provided by AZ, we explored the profile of protection by time since administration, using data from a household-randomized, placebo-controlled trial in Burkina Faso and Mali. Methods Between 2014 and 2016, 30 977 children aged 3–59 months received seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine and either AZ or placebo monthly, on 4 occasions each year. Poisson regression with gamma-distributed random effects, accounting for the household randomization and within-individual clustering of illness episodes, was used to compare incidence of prespecified outcomes between SMC+AZ versus SMC+placebo groups in fixed time strata post-treatment. The likelihood ratio test was used to assess evidence for a time-treatment group interaction. Results Relative to SMC+placebo, there was no evidence of protection from SMC+AZ against hospital admissions and deaths. Additional protection from SMC+AZ against malaria was confined to the first 2 weeks post-administration (protective efficacy (PE): 24.2% [95% CI: 17.8%, 30.1%]). Gastroenteritis and pneumonia were reduced by 29.9% [21.7; 37.3%], and 34.3% [14.9; 49.3%], respectively, in the first 2 weeks postadministration. Protection against nonmalaria fevers with a skin condition persisted up to 28 days: PE: 46.3% [35.1; 55.6%]. Conclusions The benefits of AZ-MDA are broad-ranging but short-lived. To maximize impact, timing of AZ-MDA must address the challenge of targeting asynchronous morbidity and mortality peaks from different causes. Mass administration of azithromycin (AZ-MDA) alongside seasonal malaria chemoprevention in children in Burkina Faso and Mali has broad-ranging but short-lived benefits. To maximize impact, AZ-MDA must address the challenge of targeting asynchronous peaks in morbidity and mortality from different causes. |
| Databáze: | OpenAIRE |
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