Priorities in reducing child mortality: Azithromycin and other interventions

Résumé

According to World Health Organization (WHO) estimates, the global under-5 mortality rate decreased by 59% between 1990 and 2018, from 93 to 39 deaths per 1,000 live births [1].This remarkable reduction was achieved largely by increasing the coverage of vaccination against measles and other childhood infections, rolling out new vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b, and introducing artemisinin combination treatment and long-lasting, insecticide-treated bed nets for the treatment and prevention of malaria.In 2018, a randomised trial conducted in Niger, Tanzania, and Malawi-the Macrolides Oraux pour Re ´duire les De ´cès avec un Oeil sur la Re ´sistance (MORDOR; "Oral macrolides to reduce death with an eye on resistance") study-showed that twice yearly, community-based mass treatment with a single dose of azithromycin reduced all-cause under-5 mortality by 13.5% (95% CI 6.7-19.8)[2].In children aged between 1 and 6 months, mortality was 24.9% lower in those who received azithromycin.Azithromycin is a long-acting, broad spectrum antibiotic that also has antimalarial, anti-inflammatory, and possibly antiviral properties [3,4].At the study site in Niger, where the impact of azithromycin on mortality was greatest, verbal autopsy revealed fewer deaths from malaria, dysentery, meningitis, and pneumonia in communities treated with azithromycin, the prevalence of malaria parasitaemia was reduced, and the gut pathogen load was reduced after the fourth biannual azithromycin distribution [5][6][7].Given that severe malnutrition increases the risk of life-threatening infectious diseases and is an important contributor to under-5 mortality, it seemed likely that the impact of azithromycin on mortality would be enhanced in malnourished children.The paper by Kieran O'Brien and colleagues in this issue of PLOS Medicine investigates the question, comparing the impact of azithromycin mass treatment in malnourished (underweight) versus well-nourished children at the Niger study site of MORDOR [8].The reduction in mortality in the azithromycin arm of the study (12.6 fewer deaths, 95% CI 6.9-18.5, per 1,000 person-years overall) was greater in malnourished than in well-nourished children, but not significantly so.The authors conclude that azithromycin mass treatment given to all children will have a greater impact on mortality than targeting treatment to malnourished children.While this is not unexpected, the potential impact of treating 10 times as many children on the antimicrobial susceptibility of important bacterial pathogens is an important consideration.Bacterial infections remain a major cause of mortality among newborns [9] with Staphylococcus aureus, S. pneumoniae, and group B streptococcus (GBS) among the major pathogens [10].Although the MORDOR trial excluded newborns, a recent study showed that

Citer ce document

Accès au document

Ce document est hébergé sur son dépôt institutionnel d'origine.

Auteur(s)

Statistiques

Consultations : 1

Téléchargements : 0