@article {1626, title = {Malaria Parasitemia after Mass Distribution of Azithromycin to Prevent Child Mortality in Burkina Faso: Results from a Cluster Randomized Trial.}, journal = {Am J Trop Med Hyg}, year = {2025}, month = {2025 Jun 17}, abstract = {

The twice-yearly mass distribution of azithromycin to children aged 1-59 months reduces all-cause child mortality. It has been suggested in some studies that mass azithromycin distributions may reduce malaria mortality and parasitemia; however, these studies have been conducted in the absence of seasonal malaria chemoprevention (SMC). Here, we evaluate malaria parasitemia in a cluster randomized trial of azithromycin versus a placebo in Burkina Faso, where SMC was being administered. Thin and thick smears were taken from a random sample of 15 children per cluster in 40 clusters that had been receiving twice-yearly azithromycin or a placebo for 36 months (six distributions). We found no evidence of a difference in malaria parasitemia between children in the azithromycin and placebo clusters (mean difference -6\% prevalence; 95\% CI -17\% to 6\%; P = 0.33). These results suggest that reductions in malaria parasitemia may not be a major contributor to the effect of azithromycin on child mortality in settings in which SMC is administered.

}, issn = {1476-1645}, doi = {10.4269/ajtmh.25-0093}, author = {Coulibaly, Boubacar and Sie, Ali and Ouattara, Mamadou and Bountogo, Mamadou and Compaor{\'e}, Guillaume and Compaor{\'e}, Adama and Nikiema, Moustapha and Sibiri, Nestor Demb{\'e}l{\'e} and Tiansi, J{\'e}r{\^o}me Nankon{\'e} and Lebas, Elodie and Fetterman, Ian and Hu, Huiyu and Doan, Thuy and Arnold, Benjamin F and Lietman, Thomas M and Oldenburg, Catherine E} } @article {866, title = {Effect of a single dose of oral azithromycin on malaria parasitaemia in children: a randomized controlled trial.}, journal = {Malar J}, volume = {20}, year = {2021}, month = {2021 Aug 31}, pages = {360}, abstract = {

BACKGROUND: Azithromycin has recently been shown to reduce all-cause childhood mortality in sub-Saharan Africa. One potential mechanism of this effect is via the anti-malarial effect of azithromycin, which may help treat or prevent malaria infection. This study evaluated short- and longer-term effects of azithromycin on malaria outcomes in children.

METHODS: Children aged 8 days to 59 months were randomized in a 1:1 fashion to a single oral dose of azithromycin (20\ mg/kg) or matching placebo. Children were evaluated for malaria via thin and thick smear and rapid diagnostic test (for those with tympanic temperature >= 37.5\ {\textdegree}C) at baseline and 14 days and 6 months after treatment. Malaria outcomes in children receiving azithromycin versus placebo were compared at each follow-up timepoint separately.

RESULTS: Of 450 children enrolled, 230 were randomized to azithromycin and 220 to placebo. Children were a median of 26 months and 51\% were female, and 17\% were positive for malaria parasitaemia at baseline. There was no evidence of a difference in malaria parasitaemia at 14 days or 6 months after treatment. In the azithromycin arm, 20\% of children were positive for parasitaemia at 14 days compared to 17\% in the placebo arm (P = 0.43) and 7.6\% vs. 5.6\% in the azithromycin compared to placebo arms at 6 months (P = 0.47).

CONCLUSIONS: Azithromycin did not affect malaria outcomes in this study, possibly due to the individually randomized nature of the trial. Trial registration\ This study is registered at clinicaltrials.gov (NCT03676751; registered 19 September 2018).

}, issn = {1475-2875}, doi = {10.1186/s12936-021-03895-9}, author = {Coulibaly, Boubacar and Sie, Ali and Dah, Clarisse and Bountogo, Mamadou and Ouattara, Mamadou and Compaor{\'e}, Adama and Nikiema, Moustapha and Tiansi, J{\'e}r{\^o}me Nankon{\'e} and Sibiri, Nestor Demb{\'e}l{\'e} and Brogdon, Jessica M and Lebas, Elodie and Doan, Thuy and Porco, Travis C and Lietman, Thomas M and Oldenburg, Catherine E} }