Research Article: Mass Azithromycin and Malaria Parasitemia in Niger: Results from a Community-Randomized Trial

Date Published: September 07, 2017

Publisher: The American Society of Tropical Medicine and Hygiene

Author(s): Kieran S. O’Brien, Sun Y. Cotter, Abdou Amza, Boubacar Kadri, Baido Nassirou, Nicole E. Stoller, Zhaoxia Zhou, Chris Cotter, Sheila K. West, Robin L. Bailey, Philip J. Rosenthal, Bruce D. Gaynor, Travis C. Porco, Thomas M. Lietman.


Studies designed to determine the effects of mass administration of azithromycin on trachoma have suggested that mass azithromycin distributions may also reduce the prevalence of malaria. These studies have typically examined the impact of a small number of treatments over short durations. In this prespecified substudy of a cluster-randomized trial for trachoma, we compared malaria parasitemia prevalence in 24 communities in Niger randomized to receive either annual or biannual mass azithromycin distributions over 3 years. The 12 communities randomized to annual azithromycin received three treatments during the high-transmission season, and the 12 communities randomized to biannual azithromycin received a total of six treatments: three during the high-transmission season and three during the low-transmission season. Blood samples were taken to assess malariometric indices among children in all study communities at a single time point during the high-transmission season after 3 years of the intervention. No significant differences were identified in malaria parasitemia, parasite density, or hemoglobin concentration between the annual and biannual treatment arms. When compared with annual mass azithromycin alone, additional mass azithromycin distributions given during the low-transmission season did not significantly reduce the subsequent prevalence of malaria parasitemia or parasite density after 3 years, as measured during the high-transmission season.

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Azithromycin has been proposed as a potential alternative or adjunctive option for use in the prevention and treatment of uncomplicated malaria.1–6 Though azithromycin does have antimalarial properties, evidence suggests that its activity against malaria is weak and inferior to first-line agents as monotherapy, and support for its use in combination with other antimalarial drugs remains equivocal.7,8 Azithromycin is well tolerated, however, and is considered to have minimal risk associated with use in young children and pregnant women.8–10

In this cluster-randomized trial, we were unable to demonstrate a difference in malaria parasitemia, parasite density, or hemoglobin concentration between children who received annual or biannual treatment with azithromycin after 3 years of the intervention. A previous study in Niger found a significant reduction in malaria parasitemia and parasite density in communities with an additional treatment during the low-transmission season compared with communities with a single mass treatment after 1 year.11 In this study, we assessed the effect of mass distributions of azithromycin on malaria in a different set of communities over a longer time period during the high-transmission season.




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