The New England Journal of MedicineAzithromycin during Routine Well-Infant Visits to Prevent Death

Azithromycin Administration in Infants: A Study on Mortality Prevention

A recent clinical trial in Burkina Faso aimed to evaluate the effectiveness of azithromycin administration in preventing infant mortality. Conducted in a region with high pediatric vaccine coverage but also significant infant mortality rates, this study presents critical insights into the potential benefits and limitations of using azithromycin as a preventive measure in infant healthcare.

Study Design:

• Participants: Infants aged 5 to 12 weeks from Burkina Faso, a sub-Saharan African region
• Methods: Randomized trial comparing a single dose of azithromycin (20 mg per kilogram) with placebo.
• Sample Size: 32,877 infants (16,416 in azithromycin group, 16,461 in placebo group).
• Primary Endpoint: Mortality before 6 months of age.
• Secondary Endpoints: Hospitalization and sick-child clinic visits.

Key Findings:

• Mortality Rates: 0.52% in azithromycin group vs. 0.48% in placebo group; no significant difference.
• Hospitalization and Clinic Visits: Similar rates in both groups.
• Subgroup Analysis: No mortality reduction in any prespecified subgroups.
• Overall Conclusion: No evidence supporting individual treatment of infants with azithromycin to reduce childhood mortality.

HCN Medical Memo
This study provides a stark contrast with previous studies suggesting benefits of mass azithromycin distribution, which could possibly influence better healthcare access in clinic-recruited children. Also, there is a spillover effect of the potential need for community-wide treatment to observe mortality reduction.

More on Culture & Medicine