| Mphatso Dennis Phiri, Matthew Cairns, Issaka Zongo, Frederic Nikiema, Modibo Diarra, Rakiswendé Serge Yerbanga, Amadou Barry, Amadou Tapily, Samba Coumare, Ismaila Thera, Irene Kuepfer, Paul Milligan, Halidou Tinto, Alassane Dicko, Jean Bosco Ouédraogo, Brian Greenwood, Daniel Chandramohan, Issaka Sagara 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 (Journal Article) In: Clin. Infect. Dis., vol. 73, no. 7, pp. e2379–e2386, 2021, ISSN: 1537-6591 1058-4838, (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
PMID: 33417683
PMCID: PMC8492219). @article{Phiri2021-oy,
title = {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 hound\'{e}, Burkina Faso, and bougouni, Mali},
author = {Mphatso Dennis Phiri and Matthew Cairns and Issaka Zongo and Frederic Nikiema and Modibo Diarra and Rakiswend\'{e} Serge Yerbanga and Amadou Barry and Amadou Tapily and Samba Coumare and Ismaila Thera and Irene Kuepfer and Paul Milligan and Halidou Tinto and Alassane Dicko and Jean Bosco Ou\'{e}draogo and Brian Greenwood and Daniel Chandramohan and Issaka Sagara},
doi = {10.1093/cid/ciaa1905},
issn = {1537-6591 1058-4838},
year = {2021},
date = {2021-10-01},
urldate = {2021-10-01},
journal = {Clin. Infect. Dis.},
volume = {73},
number = {7},
pages = {e2379--e2386},
publisher = {Oxford University Press (OUP)},
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.},
note = {© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
PMID: 33417683
PMCID: PMC8492219},
keywords = {Antimalarials/therapeutic use, Azithromycin, Azithromycin/therapeutic use, Burkina Faso/epidemiology, Chemoprevention, Child, child mortality, Drug Combinations, duration of protection, Humans, Infant, Malaria/drug therapy/epidemiology/prevention \& control, Mali/epidemiology, Preschool, Sahel, seasonal malaria chemoprevention, Seasons},
pubstate = {published},
tppubtype = {article}
}
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. |