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Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution
Thuy Doan1, Lee Worden1, Armin Hinterwirth1
1From 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.).
Mass azithromycin distributions in African children reduced mortality but amplified antibiotic resistance. Four years of treatment significantly increased macrolide and non-macrolide resistance determinants in the gut resistome.
Area of Science:
- Antimicrobial resistance
- Public health interventions
- Microbiome research
Background:
- Mass azithromycin distribution in sub-Saharan Africa reduces childhood mortality.
- However, this intervention increases macrolide resistance.
- Long-term effects on the gut resistome remain unclear.
Purpose of the Study:
- To investigate the impact of 4 years of mass azithromycin distribution on the gut resistome in children.
- To quantify macrolide resistance determinants in children receiving azithromycin versus placebo.
Main Methods:
- A randomized controlled trial in Niger involving 30 villages.
- Children aged 1-59 months received mass azithromycin or placebo every 6 months for 4 years.
- Rectal swabs analyzed for gut resistome at baseline, 36, and 48 months.
Main Results:
- High coverage achieved in both azithromycin (83.2%) and placebo (86.6%) groups.
- Macrolide resistance determinants were 7.5 times higher in the azithromycin group at 48 months.
- Resistance to non-macrolide antibiotics, including beta-lactams, also increased.
Conclusions:
- Four years of mass azithromycin distribution led to increased antibiotic resistance.
- The findings suggest mass azithromycin distribution may propagate antibiotic resistance.
- This highlights a critical trade-off between reducing mortality and increasing antimicrobial resistance.
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