Researchers found that child mortality rate was significantly lower in children who received a twice-yearly dose of an antibiotic called azithromycin.
It all started in 2009 when a group of eye doctors from the University of California, San Francisco released some unexpected results from a study that they had conducted in Ethiopia on an eye infection known as trachoma, which is the world’s leading cause of preventable blindness.
The ophthalmologists knew that the antibiotic azithromycin was effective at treating trachoma and had given it to tens of thousands of children between one and nine. At the same time, they kept watching whether the antibiotic seemed to have any other benefits to the children’s health.
Surprisingly, they found that mass azithromycin treatment that was given twice a year seemed to have decreased childhood deaths. The researchers found that the child mortality rate decreased significantly in the group of children who received azithromycin.
However, the study did not address the question of what exactly caused that reduction. The researchers suspect that azithromycin provides a broad defense against various gastrointestinal and respiratory bacteria, which commonly affect young children in developing countries and can be fatal if left untreated.
In spite of the study’s promising results, many global health specialists are concerned that widespread use of an antibiotic in children would increase the risk of antibiotic resistance.
Jeremy Keenan, a UCSF ophthalmologist, and his colleagues gave a mixed answer to that question. In Niger, they found that the childhood mortality-rate reduction remained about the same even after administering azithromycin twice-yearly for three years, suggesting that the drug continued to be effective and had not lost its steam over time against resistant bacteria.
Dr. Keenan said, “Our group definitely thinks antimicrobial resistance is still a big issue. But if it’s the case that there’s more resistance and the mortality benefit goes away over time, we should be able to see that.”
Many public health officials are still skeptical. Epidemiologist Nicola Low said, “It doesn’t really alleviate my concerns about the potential for antibiotic resistance.” She added, “Most of the infections kids get are not fatal. So even if there is resistance circulating, you would need to have a massive impact on death for it to be measurable.”
Dr. Keenan said, “Antibiotics are always an add-on. They can never replace vaccinations, clean water or primary care. But with an antibiotic, you get a big bang for your buck.”
The research is not over yet, as Dr. Keenan and his colleagues will be hoping to extend the trial to infants younger than a month, who often die from the bacterial infections. Another epidemiologist Aaron Milstone said, “They haven’t completely reassured that this has long-term safety. There’s a lot of concern about early childhood antibiotic exposure, how might that set you up for other diseases later in life. But if I lived there and had to take the risk, now versus later in life, I’d take the azithromycin.”
