Mass drug administration of azithromycin: an analysis.

Infant Child Humans Azithromycin / therapeutic use Mass Drug Administration Anti-Bacterial Agents / therapeutic use Drug Resistance, Microbial Risk Assessment
Antibiotic resistance Azithromycin Childhood mortality Infectious disease Mass drug administration

Journal

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420

Informations de publication

Date de publication:
Mar 2023
Historique:
received: 17 06 2022
revised: 13 10 2022
accepted: 16 10 2022
pubmed: 30 10 2022
medline: 4 3 2023
entrez: 29 10 2022
Statut: ppublish

Résumé

WHO recommends mass drug administration (MDA) of the antibiotic azithromycin for children aged 1-11 months in areas with high rates of infant and child mortality. Notwithstanding the substantial potential benefits of lowering childhood mortality, MDA raises understandable concerns about exacerbating antibiotic resistance. In this study, we aimed to evaluate the use of MDA using both quantitative and ethical considerations. We performed a series of literature searches between July 2019 and June 2022. We first compared MDA with other uses of antibiotics using the standard metric of 'number needed to treat', and five additional criteria: (1) other widely accepted uses of anti-infectives (2) absolute use (i.e. total number), of antibiotics, (3) risk-benefit trade-off, (4) availability of short-term alternatives, and (5) the precedent for implementing similar interventions. We found that MDA falls well within a justifiable range when compared with widely accepted uses of antibiotics in terms of the number needed to treat. The other five criteria we considered provided further support for the use of MDA to prevent childhood mortality. Although better data on antibiotic use and resistance are needed, efforts to reduce antibiotic use and resistance should not start with halting MDA of azithromycin in the areas with the highest rates of childhood mortality. Improving data to inform this decision is critical. However, on the basis of the best evidence available, we believe that concerns regarding resistance should not thwart MDA; instead, MDA should be accompanied by robust plans to monitor its efficacy and changes in resistance levels. Similar considerations could be included in a framework for evaluating the benefits of antibiotics against the risk of resistance in other contexts.

Sections du résumé

BACKGROUND BACKGROUND
WHO recommends mass drug administration (MDA) of the antibiotic azithromycin for children aged 1-11 months in areas with high rates of infant and child mortality. Notwithstanding the substantial potential benefits of lowering childhood mortality, MDA raises understandable concerns about exacerbating antibiotic resistance.
OBJECTIVES OBJECTIVE
In this study, we aimed to evaluate the use of MDA using both quantitative and ethical considerations.
SOURCES METHODS
We performed a series of literature searches between July 2019 and June 2022.
CONTENT BACKGROUND
We first compared MDA with other uses of antibiotics using the standard metric of 'number needed to treat', and five additional criteria: (1) other widely accepted uses of anti-infectives (2) absolute use (i.e. total number), of antibiotics, (3) risk-benefit trade-off, (4) availability of short-term alternatives, and (5) the precedent for implementing similar interventions. We found that MDA falls well within a justifiable range when compared with widely accepted uses of antibiotics in terms of the number needed to treat. The other five criteria we considered provided further support for the use of MDA to prevent childhood mortality.
IMPLICATIONS CONCLUSIONS
Although better data on antibiotic use and resistance are needed, efforts to reduce antibiotic use and resistance should not start with halting MDA of azithromycin in the areas with the highest rates of childhood mortality. Improving data to inform this decision is critical. However, on the basis of the best evidence available, we believe that concerns regarding resistance should not thwart MDA; instead, MDA should be accompanied by robust plans to monitor its efficacy and changes in resistance levels. Similar considerations could be included in a framework for evaluating the benefits of antibiotics against the risk of resistance in other contexts.

Identifiants

DOI: 10.1016/j.cmi.2022.10.022 PMID: 36309328
pubmed: 36309328
pii: S1198-743X(22)00536-5
doi: 10.1016/j.cmi.2022.10.022
pii:
doi:

Substances chimiques

Azithromycin 83905-01-5
Anti-Bacterial Agents 0

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

326-331

Informations de copyright

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

Rebecca Kahn (R)

Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA. Electronic address: rek160@mail.harvard.edu.

Nir Eyal (N)

Center for Population-Level Bioethics, Rutgers University, New Brunswick, NJ, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA; Department of Philosophy, Rutgers University, New Brunswick, NJ, USA.

Samba O Sow (SO)

Centre pour le Développement des Vaccins (CVD-Mali), Ministère de La Santé, BP251, Bamako, Mali; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.

Marc Lipsitch (M)

Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Composés chimiques organiques › Lactones › Érythromycine › Azithromycine › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Contrôle des maladies transmissibles › Administration massive de médicament › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Phénomènes physiologiques › Phénomènes pharmacologiques et toxicologiques › Phénomènes pharmacologiques › Résistance aux substances › Résistance microbienne aux médicaments › Mass drug administration of azithromycin: an analysis.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › Mass drug administration of azithromycin: an analysis.