The Duration of Protection from Azithromycin Against Malaria, Acute Respiratory, Gastrointestinal, and Skin Infections When Given Alongside Seasonal Malaria Chemoprevention: Secondary Analyses of Data from a Clinical Trial in Houndé, Burkina Faso, and Bougouni, Mali.
The Duration of Protection from Azithromycin Against Malaria, Acute Respiratory, Gastrointestinal, and Skin Infections When Given Alongside Seasonal Malaria Chemoprevention: Secondary Analyses of Data from a Clinical Trial in Houndé, Burkina Faso, and Bougouni, Mali.
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DOI：
10.1093/cid/ciaa1905
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发表时间：
2021-10-05
期刊：
影响因子：
--
通讯作者：
Sagara I
中科院分区：
文献类型：
--
作者：
Phiri MD;Cairns M;Zongo I;Nikiema F;Diarra M;Yerbanga RS;Barry A;Tapily A;Coumare S;Thera I;Kuepfer I;Milligan P;Tinto H;Dicko A;Ouédraogo JB;Greenwood B;Chandramohan D;Sagara I
阿奇霉素 (AZ) 的大规模给药 (MDA) 被认为是促进撒哈拉以南非洲儿童生存的一种策略，但阿奇霉素降低死亡率的机制尚不清楚。为了更好地了解 AZ 提供的保护的性质和程度，我们使用布基纳法索和马里的家庭随机、安慰剂对照试验的数据，探索了自给药以来的保护情况。 2014 年至 2016 年间，30 977 名 3-59 个月的儿童接受了季节性疟疾化学预防 (SMC)，每月使用磺胺多辛-乙胺嘧啶加阿莫地喹和 AZ 或安慰剂，每年 4 次。具有伽玛分布随机效应的泊松回归考虑了家庭随机化和疾病发作的个体内聚类，用于比较 SMC+AZ 组与 SMC+安慰剂组在治疗后固定时间层中预定结果的发生率。似然比检验用于评估时间治疗组相互作用的证据。相对于 SMC+安慰剂，没有证据表明 SMC+AZ 可以预防住院和死亡。 SMC+AZ 对疟疾的额外保护仅限于给药后的前 2 周（保护效力 (PE)：24.2% [95% CI：17.8%，30.1%]）。胃肠炎和肺炎减少了29.9%[21.7; 37.3%]和34.3%[14.9； 49.3%]，分别在给药后的前两周内。对患有皮肤病的非疟疾发烧的保护持续长达 28 天：PE：46.3% [35.1； 55.6%]。 AZ-MDA 的好处广泛但短暂。为了最大限度地发挥影响，AZ-MDA 的时机必须解决针对不同原因导致的异步发病率和死亡率峰值的挑战。在布基纳法索和马里的儿童中，大规模施用阿奇霉素（AZ-MDA）和季节性疟疾化学预防具有广泛但短暂的益处。为了最大限度地发挥影响，AZ-MDA 必须应对不同原因导致的发病率和死亡率异步峰值的挑战。
Mass drug administration (MDA) with azithromycin (AZ) is being considered as a strategy to promote child survival in sub-Saharan Africa, but the mechanism by which AZ reduces mortality is unclear. To better understand the nature and extent of protection provided by AZ, we explored the profile of protection by time since administration, using data from a household-randomized, placebo-controlled trial in Burkina Faso and Mali. Between 2014 and 2016, 30 977 children aged 3–59 months received seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine and either AZ or placebo monthly, on 4 occasions each year. Poisson regression with gamma-distributed random effects, accounting for the household randomization and within-individual clustering of illness episodes, was used to compare incidence of prespecified outcomes between SMC+AZ versus SMC+placebo groups in fixed time strata post-treatment. The likelihood ratio test was used to assess evidence for a time-treatment group interaction. Relative to SMC+placebo, there was no evidence of protection from SMC+AZ against hospital admissions and deaths. Additional protection from SMC+AZ against malaria was confined to the first 2 weeks post-administration (protective efficacy (PE): 24.2% [95% CI: 17.8%, 30.1%]). Gastroenteritis and pneumonia were reduced by 29.9% [21.7; 37.3%], and 34.3% [14.9; 49.3%], respectively, in the first 2 weeks postadministration. Protection against nonmalaria fevers with a skin condition persisted up to 28 days: PE: 46.3% [35.1; 55.6%]. The benefits of AZ-MDA are broad-ranging but short-lived. To maximize impact, timing of AZ-MDA must address the challenge of targeting asynchronous morbidity and mortality peaks from different causes. Mass administration of azithromycin (AZ-MDA) alongside seasonal malaria chemoprevention in children in Burkina Faso and Mali has broad-ranging but short-lived benefits. To maximize impact, AZ-MDA must address the challenge of targeting asynchronous peaks in morbidity and mortality from different causes.
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影响因子：
7.7
作者：
Etard, JF;Le Hesran, JY;Delaunay, V
通讯作者：
Delaunay, V
影响因子：
11.8
作者：
Andersen, SL;Oloo, AJ;Shanks, GD
通讯作者：
Shanks, GD
DOI：
10.1016/s0011-393x(02)80007-8
发表时间：
2002-01-01
影响因子：
1.9
作者：
Pacifico, L;Chiesa, C
通讯作者：
Chiesa, C
影响因子：
3
作者：
Dalrymple U;Arambepola R;Gething PW;Cameron E
通讯作者：
Cameron E
影响因子：
7.7
作者：
Delaunay, V;Etard, JF;Simondon, F
通讯作者：
Simondon, F