No Effect of Adding Azithromycin to Seasonal Malaria Chemoprevention

The addition of azithromycin to seasonal malaria chemoprevention may reduce mortality and morbidity in African children, according to a study recently published in the New England Journal of Medicine.

A sustained reduction in all-cause mortality was seen in Ethiopian children after a mass administration of azithromycin for trachoma. Therefore, this study investigated whether adding azithromycin to the monthly sulfadoxine-pyrimethamine plus amodiaquine used for seasonal malaria chemoprevention reduced mortality and morbidity in African children (ClinicalTrials.gov identifier: NCT02211729).

In Burkina Faso and Mali, 19,578 children aged 3 to 59 months were randomly assigned, on the basis of household, to receive seasonal malaria chemoprevention plus either azithromycin (n=9735) or placebo (n=9843). Once children reached age 5 years, they exited the trial and new children were enrolled. For 3 successive seasons, the interventions were administered in four 3-day cycles at monthly intervals. The primary end point was death or hospitalization for at least 24 hours that was not a result of elective surgery or trauma.

During 3 malaria-transmission seasons, the number of deaths and hospital admissions was 250 in the azithromycin group and 238 in the placebo group (incidence rate ratio [IRR], 1.1; 95% CI, 0.88-1.3). In the azithromycin group, the following events occurred less than in the placebo group: gastrointestinal infections (1647 vs 1985 episodes; IRR, 0.85; 95% CI, 0.79-0.91), upper respiratory tract infections (4893 vs 5763 episodes; IRR, 0.85; 95% CI, 0.81-0.90), and nonmalarial febrile illnesses (1122 vs 1424 episodes; IRR, 0.79; 95% CI, 0.73-0.87). In both groups, the incidence of adverse events and the prevalence of malaria parasitemia were similar.

Overall, the study authors concluded that, in “children in Burkina Faso and Mali, the addition of azithromycin to the antimalarial agents used for seasonal malaria chemoprevention did not result in a lower incidence of death or hospital admission that was not due to trauma or surgery than antimalarial agents plus placebo, although a lower disease burden was noted with azithromycin than with placebo.”

Reference

Chandramohan D, Dicko A, Zongo I, et al. Effect of adding azithromycin to seasonal malaria chemoprevention [published online January 30, 2019]. N Engl J Med. doi: 10.1056/NEJMoa1811400