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Can Azithromycin Prophylaxis Prevent Child Death?


Would administering a routine dose of azithromycin (a common antibiotic) to large numbers of children, regardless of whether they were ill or not, improve child survival? This rather unorthodox question was actually tested in a massive research initiative, whose results were announced this month.


The journal The Lancet Infectious Diseases published this research summary statement, “Speaking at a web broadcast hosted by the Massachusetts Medical Society and the New England Journal of Medicine on April 27, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, welcomed the reduction in child mortality shown in the MORDOR trial (funded by the Gates Foundation) published the previous day. The trial randomised children younger than 5 years in communities in three countries in sub-Saharan Africa to receive twice yearly mass treatment with oral azithromycin or placebo. All-cause mortality over 2 years, the primary outcome, was 13·5% (95% CI 6·7–19·8) lower in children in communities that received azithromycin compared with those that received placebo.”


While this result is indeed encouraging, a plethora of intriguing and worthy questions are stimulated, including:

• What are the actual biological mechanisms through which these children are protected?

• What are the potential effects of mass drug administration on adverse medication reactions and development of antibiotic resistance?

• Did administration of this study divert healthcare resources away from responding to children who were identified as ill?


Child health breakthroughs are inspiring – and this study is one of the most important steps forward in years. However, attending to such questions is an essential component in responsible investigation.


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