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Macrolide and Nonmacrolide Resistance After 36 Months of Mass Azithromycin Distribution in Burkina Faso: A Cluster

Catherine E Oldenburg1,2,3,4, Boubacar Coulibaly5, Ali Sié1,4,5

  • 1Francis I Proctor Foundation, University of California, SanFrancisco, CA, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 2, 2026
PubMed

Insights

Biannual mass azithromycin distribution to young children did not increase antimicrobial resistance (AMR) genetic determinants in Burkina Faso. This study monitored AMR in children receiving azithromycin versus placebo over 36 months.

Area of Science:

  • Global health
  • Infectious disease epidemiology
  • Antimicrobial stewardship

Background:

  • Biannual mass azithromycin distribution reduces child mortality but may drive antimicrobial resistance (AMR).
  • The World Health Organization (WHO) recommends AMR surveillance during mass drug administration programs.
  • This study investigated the impact of azithromycin distribution on gut AMR in children in Burkina Faso.

Purpose of the Study:

  • To evaluate the effect of twice-yearly azithromycin distribution on AMR in children.
  • To compare macrolide and non-macrolide resistance determinants between azithromycin and placebo groups.

Main Methods:

  • A 1:1 cluster randomized placebo-controlled trial (Community Health with Azithromycin Trial - CHAT) in Burkina Faso (2019-2023).
  • Communities received azithromycin or placebo twice yearly.
  • Rectal swabs from children were analyzed for AMR genetic determinants using next-generation DNA sequencing at 36 months.

Main Results:

  • Analysis of 483 samples from 41 communities at 36 months.
  • No statistically significant difference in macrolide resistance determinants between azithromycin and placebo groups (fold-change 1.21, P=0.62).
  • No significant difference observed in non-macrolide resistance genes, including beta-lactam resistance (fold-change 1.05, P=0.81).

Conclusions:

  • Twice-yearly azithromycin distribution in this Burkina Faso setting did not result in statistically significant increases in macrolide or non-macrolide genetic resistance determinants at 36 months.
  • Findings contribute to understanding AMR surveillance in mass drug administration programs.
Abstract

Keywords:
antimicrobial resistanceazithromycinchild mortalitymass drug administration

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