2
|
Phiri MD, Cairns M, Zongo I, Nikiema F, Diarra M, Yerbanga RS, Barry A, Tapily A, Coumare S, Thera I, Kuepfer I, Milligan P, Tinto H, Dicko A, Ouédraogo JB, Greenwood B, Chandramohan D, Sagara I. 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. Clin Infect Dis 2021; 73:e2379-e2386. [PMID: 33417683 PMCID: PMC8492219 DOI: 10.1093/cid/ciaa1905] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Mphatso Dennis Phiri
- Malaria Epidemiology Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Matthew Cairns
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Issaka Zongo
- Le Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Frederic Nikiema
- Le Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Modibo Diarra
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Rakiswendé Serge Yerbanga
- Le Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Amadou Barry
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Amadou Tapily
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Samba Coumare
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Ismaila Thera
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Irene Kuepfer
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul Milligan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Halidou Tinto
- Le Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Alassane Dicko
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Jean Bosco Ouédraogo
- Le Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Issaka Sagara
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| |
Collapse
|
3
|
Oldenburg CE, Hinterwirth A, Worden L, Sié A, Dah C, Ouermi L, Coulibaly B, Zhong L, Chen C, Ruder K, Lietman TM, Keenan JD, Doan T. Indirect effect of oral azithromycin on the gut resistome of untreated children: a randomized controlled trial. Int Health 2021; 13:130-134. [PMID: 32556194 PMCID: PMC7902679 DOI: 10.1093/inthealth/ihaa029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 11/14/2022] Open
Abstract
Background Antibiotic use by one individual may affect selection for antimicrobial resistance in close contacts. Here we evaluated whether oral antibiotic treatment of one child within a household affected the gut resistome of an untreated cohabiting child. Methods Households with at least two children <5 y of age were randomized in a 1:1 fashion to a 5d course of azithromycin or placebo. To evaluate indirect effects of azithromycin treatment on the gut resistome, we randomly assigned one child in the house to azithromycin and one to placebo. In placebo households, each child received placebo. We performed DNA sequencing of rectal swabs collected 5 d after the last antibiotic dose. We estimated risk ratios for the presence of genetic resistance determinants at the class level using modified Poisson models for children in azithromycin households compared with placebo households and assessed the composition of the resistome using permutational analysis of variance (PERMANOVA). Results Of 58 children (n = 30 azithromycin households, n = 28 placebo households) with post-treatment rectal swabs, genetic resistance determinants were common but there was no significant difference at the class (p = 0.54 for macrolides) or gene (p = 0.94 for structure by PERMANOVA, p = 0.94 for diversity) level between untreated children in azithromycin households compared with placebo households. Conclusions The results are encouraging that one child's antibiotic use may not influence the resistome of another child. Trial registration:ClinicalTrials.gov NCT03187834.
Collapse
Affiliation(s)
- Catherine E Oldenburg
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Armin Hinterwirth
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Lee Worden
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Lucienne Ouermi
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Boubacar Coulibaly
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Lina Zhong
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Cindi Chen
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kevin Ruder
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Thuy Doan
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|