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Sub-Saharan African countries could cut high rates of child mortality if the World Health Organization recommended expanding the use of a crucial antibiotic beyond the earliest age group, according to new research.
The UN global health body said it was reviewing the work and other related research to decide whether it should expand existing guidance that the drug azithromycin be given regularly to infants between 1 month and 11 months old to include children up to 5 years old.
The researchers from University of California, San Francisco argue that the benefits from the expanded use of azithromycin outweigh the danger that it could stoke the evolution of antibiotic-resistant “superbugs”.
The case highlights a central dilemma in public health, as so-called anti-microbial resistance (AMR) to existing drugs is already estimated to contribute to millions of deaths every year.
“We’re taught in medicine to avoid using antibiotics in a non-specific way because of the potential for antibiotic resistance,” said Thomas Lietman, senior author of a paper on the work published in the New England Journal of Medicine on Wednesday.
“But we’ve found if you do that in an organised fashion, it can reduce childhood mortality.”
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The latest research followed a 2018 study that found a two-year prescription of azithromycin for children in Niger, Malawi and Tanzania cut mortality by nearly 14 cent in under-5s and by 25 per cent for babies of less than five months.
Azithromycin is a so-called broad spectrum antibiotic active against pathogens that are among the biggest killers of children in Africa, through diseases including respiratory infections, diarrhoea and malaria.
In 2019, the WHO recommended sub-Saharan African countries consider mass administration of azithromycin to infants aged between one month and 11 months, in areas of high child mortality. It called on countries to monitor for anti-microbial resistance.
The latest study, dubbed Avenir, focused on Niger and was a collaboration with the health ministry and other researchers in the country. The west African nation had a UN-estimated mortality rate for under-5s of 117 per 1,000 live births in 2022, the highest in the world.
Military leaders overthrew the elected government in the Sahel country last July, just after the Avenir fieldwork was completed.
Avenir compared a group in which azithromycin was given to all under-5s with one where it was administered only to infants between one and 11 months. It found that mortality among the infants was 17 per cent lower in the group where the other children under-5 also took the antibiotic.
Azithromycin is used to treat respiratory infections, diarrhoea and malaria, among the biggers killers of children in Africa © Soumyabrata Roy/NurPhoto/NurPhoto/Getty Images
The researchers suggest that giving the older children azithromycin benefits their even more vulnerable baby siblings, too. The older children are more likely to be socialising with peers outside the home, increasing the risk that they will bring infections back with them.
The researchers still have to finish analysing the study specimens for AMR. They say the process was delayed, because of uncertainties caused by the Niger coup meant shipping times were much longer than expected.
Routine antibiotic dosing has been used to control other diseases. Sulfadoxine is part of a drug combination deployed to prevent malaria — although pathogenic resistance to it and other antimalarial medicines is a growing problem.
The WHO said it was establishing a group to review evidence about the impact of the mass administration of azithromycin on babies and other young children.
It would use this review to decide if it should update its existing guidance, it added, noting that several other studies on azithromycin strategies were due to be published this year and next.
Data visualisation by Janina Conboye
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