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A new study conducted in Niger has brought to light the potential benefits of administering azithromycin not just to infants, but also to their older siblings. The research, published online on July 10, 2025, in JAMA Network Open, suggests that mass drug administration (MDA) of azithromycin to both infants (aged 1-11 months) and children (aged 12-59 months) in the same household reduced infant mortality more than treating infants alone.
Key Findings
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Infants living in homes where both they and their older siblings received azithromycin had a lower mortality rate compared to those in homes where only infants were treated.
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Mortality rates among infants (per 1,000 person-years) were lowest in groups where both age ranges were medicated (18.5 deaths) compared to infants-only (22.3 deaths) or placebo groups (23.9 deaths).
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In communities where azithromycin was administered, there was an overall 23% decline in mortality among infants compared to placebo. Of this benefit, 76.5% appeared attributable to also treating older children, suggesting a significant household “spillover effect.”
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The study’s methodology was a secondary analysis of a large, cluster-randomized trial involving nearly 99,000 infants who met the inclusion criteria from November 2020 to July 2023.
Implications and Expert Commentary
Authors of the study suggest these findings support expanding azithromycin MDA to include all children under five years for maximal health benefit, particularly in high-mortality settings. They note the reduction in infant deaths may be partly due to the indirect protection offered when older siblings in the household are also medicated—a community-level approach with potentially profound public health implications.
Study Limitations
Despite the notable findings, the interaction effect was not statistically significant, likely due to limited statistical power in subgroup analyses. Furthermore, the study design did not allow assessment of specific causes of death, restricting a more granular understanding of how the “spillover effect” works.
Funding and Disclosures
The research was supported by the Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases at the NIH, with drug supplies donated by Pfizer, Inc. Some authors have reported receiving grants from these organizations.
Disclaimer:
This article summarizes research findings and is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
