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Published on: November 16, 2016
Mass drug administration of azithromycin: an analysis
Rebecca Kahn1, Nir Eyal2, Samba O Sow3
1Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Background:
WHO recommends mass drug administration (MDA) of the antibiotic azithromycin for children aged 1-11 months in areas with high rates of infant and child mortality. Notwithstanding the substantial potential benefits of lowering childhood mortality, MDA raises understandable concerns about exacerbating antibiotic resistance.
Objectives:
In this study, we aimed to evaluate the use of MDA using both quantitative and ethical considerations.
Sources:
We performed a series of literature searches between July 2019 and June 2022.
Content:
We first compared MDA with other uses of antibiotics using the standard metric of 'number needed to treat', and five additional criteria: (1) other widely accepted uses of anti-infectives (2) absolute use (i.e. total number), of antibiotics, (3) risk-benefit trade-off, (4) availability of short-term alternatives, and (5) the precedent for implementing similar interventions. We found that MDA falls well within a justifiable range when compared with widely accepted uses of antibiotics in terms of the number needed to treat. The other five criteria we considered provided further support for the use of MDA to prevent childhood mortality.
Implications:
Although better data on antibiotic use and resistance are needed, efforts to reduce antibiotic use and resistance should not start with halting MDA of azithromycin in the areas with the highest rates of childhood mortality. Improving data to inform this decision is critical. However, on the basis of the best evidence available, we believe that concerns regarding resistance should not thwart MDA; instead, MDA should be accompanied by robust plans to monitor its efficacy and changes in resistance levels. Similar considerations could be included in a framework for evaluating the benefits of antibiotics against the risk of resistance in other contexts.
Insights
Mass drug administration (MDA) of azithromycin for children is recommended by WHO to reduce child mortality. This study supports MDA, finding its benefits outweigh concerns about antibiotic resistance, urging continued use with monitoring.
Area of Science:
- Global Health
- Infectious Disease Epidemiology
- Antimicrobial Stewardship
Background:
- WHO recommends mass drug administration (MDA) of azithromycin for children aged 1-11 months in high child mortality areas.
- MDA's potential to reduce childhood mortality is significant, but concerns exist regarding increased antibiotic resistance.
Purpose of the Study:
- To evaluate the use of MDA for childhood mortality prevention using quantitative and ethical considerations.
- To compare MDA with other antibiotic uses based on established metrics and criteria.
Main Methods:
- Conducted literature searches from July 2019 to June 2022.
- Compared MDA to other antibiotic uses using 'number needed to treat' and five additional criteria (other anti-infective uses, absolute antibiotic use, risk-benefit, alternatives, precedent).
Main Results:
- MDA's 'number needed to treat' is comparable to widely accepted antibiotic uses.
- Additional criteria supported the use of MDA for preventing childhood mortality, indicating a justifiable risk-benefit balance.
Conclusions:
- Concerns about antibiotic resistance should not halt MDA of azithromycin in high-mortality areas.
- Continued MDA is supported by current evidence, but requires robust monitoring of efficacy and resistance levels.
- Improved data on antibiotic use and resistance is critical for informed decision-making.
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