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Date: August 21, 2024
In a groundbreaking study, researchers from the University of California, San Francisco (UCSF) have found that administering the antibiotic azithromycin to all children under five in Sub-Saharan Africa could significantly reduce mortality rates. The study suggests that expanding the treatment beyond infants, as currently recommended by the World Health Organization (WHO), could save countless lives in a region where 1 in 10 children do not survive past their fifth birthday.
The WHO initially recommended the mass administration of azithromycin only to infants between 1 and 11 months old following a 2018 study that showed a 14% reduction in under-five mortality when the antibiotic was administered in three African countries: Niger, Malawi, and Tanzania. However, the latest findings, published on August 21 in the New England Journal of Medicine, demonstrate that this intervention is most effective when extended to all children up to 5 years old.
Why the Expansion Matters
The study’s lead author, Dr. Kieran S. O’Brien, an epidemiologist at UCSF, emphasized that treating older children is crucial for protecting younger, more vulnerable siblings. “By treating the older kids, you can protect the younger children, who are particularly vulnerable,” Dr. O’Brien explained. The research indicates that older children, who are more likely to be exposed to and transmit infections, play a significant role in the spread of potentially deadly pathogens within households.
Azithromycin is known for its broad-spectrum efficacy, targeting a range of pathogens responsible for respiratory infections, diarrhea, and malaria—some of the leading causes of childhood mortality in Sub-Saharan Africa. The initial study in 2018 demonstrated a 25% reduction in mortality for babies under 5 months old, prompting the WHO to recommend the antibiotic for this age group. However, the newly published AVENIR study, conducted in partnership with the Niger Ministry of Health, revealed that under-five mortality only decreased significantly when the treatment was extended to all children up to 5 years old.
Addressing Concerns Over Antibiotic Resistance
While there are legitimate concerns about the potential for antibiotic resistance, the researchers argue that the benefits of the intervention outweigh the risks. Dr. Thomas M. Lietman, the study’s senior author, acknowledged the importance of cautious antibiotic use but emphasized that in this context, the organized administration of azithromycin could drastically reduce mortality in a region where healthcare resources are often limited.
“We’re taught in medicine to avoid using antibiotics in a nonspecific way because of the potential for antibiotic resistance,” Dr. Lietman noted. “But we’ve found that if you do this in an organized fashion, it can reduce childhood mortality. How can you withhold a treatment that reduces mortality by 14% in areas where 10% of the kids aren’t reaching their fifth birthday?”
The UCSF researchers hope that their findings will prompt the WHO to reconsider its current guidelines and expand the recommendation for azithromycin treatment to include all children under 5 years old in Sub-Saharan Africa. Such a move could potentially save hundreds of thousands of lives across the region.
More Information: The study by O’Brien et al. can be found in the New England Journal of Medicine (2024). DOI: 10.1056/NEJMoa2312093.
