Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution

Villages in Niger were randomly assigned to offer azithromycin or placebo to children 1 to 59 months of age every 6 months for 4 years. Stool samples collected at 36 and 48 months showed that antibiotic resistance was more common among children living in villages that received azithromycin than amon...

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Published inThe New England journal of medicine Vol. 383; no. 20; pp. 1941 - 1950
Main Authors Doan, Thuy, Worden, Lee, Hinterwirth, Armin, Arzika, Ahmed M, Maliki, Ramatou, Abdou, Amza, Zhong, Lina, Chen, Cindi, Cook, Catherine, Lebas, Elodie, O’Brien, Kieran S, Oldenburg, Catherine E, Chow, Eric D, Porco, Travis C, Lipsitch, Marc, Keenan, Jeremy D, Lietman, Thomas M
Format Journal Article
LanguageEnglish
Published Boston Massachusetts Medical Society 12.11.2020
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Abstract Villages in Niger were randomly assigned to offer azithromycin or placebo to children 1 to 59 months of age every 6 months for 4 years. Stool samples collected at 36 and 48 months showed that antibiotic resistance was more common among children living in villages that received azithromycin than among children living in villages that received placebo.
AbstractList BackgroundMass distribution of azithromycin to preschool children twice yearly for 2 years has been shown to reduce childhood mortality in sub-Saharan Africa but at the cost of amplifying macrolide resistance. The effects on the gut resistome, a reservoir of antimicrobial resistance genes in the body, of twice-yearly administration of azithromycin for a longer period are unclear.MethodsWe investigated the gut resistome of children after they received twice-yearly distributions of azithromycin for 4 years. In the Niger site of the MORDOR trial, we enrolled 30 villages in a concurrent trial in which they were randomly assigned to receive mass distribution of either azithromycin or placebo, offered to all children 1 to 59 months of age every 6 months for 4 years. Rectal swabs were collected at baseline, 36 months, and 48 months for analysis of the participants’ gut resistome. The primary outcome was the ratio of macrolide-resistance determinants in the azithromycin group to those in the placebo group at 48 months.ResultsOver the entire 48-month period, the mean (±SD) coverage was 86.6±12% in the villages that received placebo and 83.2±16.4% in the villages that received azithromycin. A total of 3232 samples were collected during the entire trial period; of the samples obtained at the 48-month monitoring visit, 546 samples from 15 villages that received placebo and 504 from 14 villages that received azithromycin were analyzed. Determinants of macrolide resistance were higher in the azithromycin group than in the placebo group: 7.4 times as high (95% confidence interval [CI], 4.0 to 16.7) at 36 months and 7.5 times as high (95% CI, 3.8 to 23.1) at 48 months. Continued mass azithromycin distributions also selected for determinants of nonmacrolide resistance, including resistance to beta-lactam antibiotics, an antibiotic class prescribed frequently in this region of Africa.ConclusionsAmong villages assigned to receive mass distributions of azithromycin or placebo twice yearly for 4 years, antibiotic resistance was more common in the villages that received azithromycin than in those that received placebo. This trial showed that mass azithromycin distributions may propagate antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02047981.)
Villages in Niger were randomly assigned to offer azithromycin or placebo to children 1 to 59 months of age every 6 months for 4 years. Stool samples collected at 36 and 48 months showed that antibiotic resistance was more common among children living in villages that received azithromycin than among children living in villages that received placebo.
Author Worden, Lee
Hinterwirth, Armin
O’Brien, Kieran S
Doan, Thuy
Maliki, Ramatou
Chen, Cindi
Cook, Catherine
Abdou, Amza
Lipsitch, Marc
Porco, Travis C
Keenan, Jeremy D
Chow, Eric D
Lietman, Thomas M
Zhong, Lina
Oldenburg, Catherine E
Lebas, Elodie
Arzika, Ahmed M
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  fullname: Doan, Thuy
  organization: From the Francis I. Proctor Foundation (T.D., L.W., A.H., L.Z., C. Chen, C. Cook, E.L., K.S.O., C.E.O., T.C.P., J.D.K., T.M.L.), the Departments of Ophthalmology (T.D., C.E.O., T.C.P., J.D.K., T.M.L.), Epidemiology and Biostatistics (C.E.O., T.C.P., T.M.L.), and Biochemistry and Biophysics (E.D.C.), and the Institute for Global Health Sciences (T.M.L.), University of California, San Francisco, San Francisco; the Carter Center (A.M.A., R.M.), the Ministry of Health (A.A.), and the Programme National de Santé Oculaire (A.A.), Niamey, Niger; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston (M.L.)
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  surname: Hinterwirth
  fullname: Hinterwirth, Armin
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  givenname: Ahmed M
  surname: Arzika
  fullname: Arzika, Ahmed M
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  surname: Maliki
  fullname: Maliki, Ramatou
  organization: From the Francis I. Proctor Foundation (T.D., L.W., A.H., L.Z., C. Chen, C. Cook, E.L., K.S.O., C.E.O., T.C.P., J.D.K., T.M.L.), the Departments of Ophthalmology (T.D., C.E.O., T.C.P., J.D.K., T.M.L.), Epidemiology and Biostatistics (C.E.O., T.C.P., T.M.L.), and Biochemistry and Biophysics (E.D.C.), and the Institute for Global Health Sciences (T.M.L.), University of California, San Francisco, San Francisco; the Carter Center (A.M.A., R.M.), the Ministry of Health (A.A.), and the Programme National de Santé Oculaire (A.A.), Niamey, Niger; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston (M.L.)
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  surname: Abdou
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  organization: From the Francis I. Proctor Foundation (T.D., L.W., A.H., L.Z., C. Chen, C. Cook, E.L., K.S.O., C.E.O., T.C.P., J.D.K., T.M.L.), the Departments of Ophthalmology (T.D., C.E.O., T.C.P., J.D.K., T.M.L.), Epidemiology and Biostatistics (C.E.O., T.C.P., T.M.L.), and Biochemistry and Biophysics (E.D.C.), and the Institute for Global Health Sciences (T.M.L.), University of California, San Francisco, San Francisco; the Carter Center (A.M.A., R.M.), the Ministry of Health (A.A.), and the Programme National de Santé Oculaire (A.A.), Niamey, Niger; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston (M.L.)
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  givenname: Thomas M
  surname: Lietman
  fullname: Lietman, Thomas M
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10.1016/S0140-6736(13)62182-0
10.1093/nar/gkw1009
10.1056/NEJMoa1715474
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  doi: 10.1093/nar/gkw1009
– ident: e_1_3_4_3_2
  doi: 10.1056/NEJMoa1715474
– ident: e_1_3_4_21_2
  doi: 10.4269/ajtmh.18-0791
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Snippet Villages in Niger were randomly assigned to offer azithromycin or placebo to children 1 to 59 months of age every 6 months for 4 years. Stool samples collected...
BackgroundMass distribution of azithromycin to preschool children twice yearly for 2 years has been shown to reduce childhood mortality in sub-Saharan Africa...
BACKGROUNDMass distribution of azithromycin to preschool children twice yearly for 2 years has been shown to reduce childhood mortality in sub-Saharan Africa...
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crossref
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StartPage 1941
SubjectTerms Antibiotic resistance
Antibiotics
Antimicrobial resistance
Azithromycin
Child mortality
Children
Deoxyribonucleic acid
DNA
Drug resistance
Genetic testing
Genomes
Intervention
Rectum
Streptococcus infections
β-Lactam antibiotics
Title Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution
URI https://nejm.org/doi/full/10.1056/NEJMoa2002606
https://www.proquest.com/docview/2459643316
https://search.proquest.com/docview/2460081630
Volume 383
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