Mass Azithromycin Distribution and Community Microbiome: A Cluster-Randomized Trial

Open Forum Infectious Diseases
Thuy DoanThomas M Lietman

Abstract

Mass distributions of oral azithromycin have long been used to eliminate trachoma, and they are now being proposed to reduce childhood mortality. The observed benefit appears to be augmented with each additional treatment, suggesting a possible community-level effect. Here, we assess whether 2 biannual mass treatments of preschool children affect the community's gut microbiome at 6 months after the last distribution. In this cluster-randomized controlled trial, children aged 1-60 months in the Dossa region of Niger were randomized at the village level to receive a single dose of azithromycin or placebo every 6 months. Fecal samples were collected 6 months after the second treatment for metagenomic deep sequencing. The prespecified primary outcome was the Euclidean PERMANOVA of the gut microbiome, or effectively the distance between the genus-level centroid at the community level, with the secondary outcome being the Simpson's α diversity. In the azithromycin arm, the gut microbial structures were significantly different than in the placebo arm (Euclidean PERMANOVA, P < .001). Further, the diversity of the gut microbiome in the azithromycin arm was significantly lower than in the placebo arm (inverse Simpson's index, P = .005). ...Continue Reading

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Citations

Jun 6, 2019·The New England Journal of Medicine·Thuy DoanUNKNOWN MORDOR Study Group
Jun 6, 2019·The New England Journal of Medicine·Jeremy D KeenanThomas M Lietman
Mar 14, 2020·Tropical Medicine & International Health : TM & IH·Georgia R Gore-LangtonJean Bosco Ouedraogo
Jun 1, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Catherine E OldenburgThuy Doan
Jun 12, 2020·The American Journal of Tropical Medicine and Hygiene·Armin HinterwirthCatherine E Oldenburg
Jul 28, 2020·International Forum of Allergy & Rhinology·Axel E RenteriaMartin Desrosiers

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