UC LogoTrachoma is a contagious eye disease which is claimed to be prevalent in Ethiopia and a number of other developing nations. It is known to mostly affect children as they have a higher chance of getting dirty. But now according to a study, it is seen that children in Ethiopia who received the antibiotic azithromycin, as a way for controlling the contagious eye disease trachoma may have a lower probability of death as opposed to the children who did not receive the antibiotic.

Ethiopia is a country which may be an endemic for viral diseases. It supposedly ranks 7th among the world’s 22 high-burden tuberculosis (TB) countries. So a lot of deaths occur in Ethiopia due to a large number of diseases that affect the people.

The authors commented, “The World Health Organization has recommended mass distribution and administration of oral azithromycin as part of efforts to control blinding trachoma. Such distribution has proven effective against the ocular strains of Chlamydia trachomatis that cause the disease at both the individual and village levels.”

The treatment may also have unintentional effects which may be both injurious and advantageous, including the inducement of antibiotic resistance.

The authors mentioned, “Conversely, antibiotics may reduce both respiratory and gastrointestinal infections, and possibly reduce rates of malaria—all of which are major causes of death in children in trachoma-endemic areas such as rural Ethiopia.”

Travis C. Porco, Ph.D., M.P.H., of the University of California, San Francisco, and his colleagues carried out the study. They observed the outcome of oral azithromycin circulation for trachoma control on mortality among children aged between 1 to 9 in Ethiopia. About forty-eight communities called as subkebeles were supposedly randomized into 1 of 3 treatment schedules. The 1st was the annual treatment of all residents which approximately included 15,902 participants. The 2nd was the biannual treatment of all residents which incorporated about 17,288 participants. The 3rd was the quarterly treatment of children which apparently included only 14,716 participants or into 1 group for which treatment was postponed by 1 year which incorporated about 18,498 control participants.

Twelve subkebeles were apparently randomized to each of the 4 schedules with all children in each of the three communities being entitled for treatment. From May 2006 to May 2007, the trial was conducted in a field setting in rural Ethiopia. Among children from age 1 to 9 years at all visits, the antibiotic coverage rates apparently exceeded about 81 percent.

At the 2007 census, an approximate number of 82 deaths were recorded for children aged 1 to 9 years. The mortality rate between the 2 groups was compared. It was found that as compared to the children in the control group, the children in the treatment group apparently had an approximate 49 percent lower odds of death.

The authors further remarked, “It is not clear precisely why azithromycin decreased mortality, although infectious diseases are the leading cause of death in Ethiopian children, in particular pneumonia (28 percent), diarrhea (20 percent), and malaria (20 percent). In Ethiopia, azithromycin is likely effective against the major pathogenic causes of lower respiratory infections such as Streptococcus pneumoniae and Haemophilus influenzae, and may have some effect against major causes of bacterial diarrhea such as Escherichia coli and Clostridium jejuni. Azithromycin has also been shown to have efficacy in the prevention and treatment of malaria due to both Plasmodium falciparum and Plasmodium vivax.”

The authors add that the dangers of nonspecific antibiotic use could have been well-described in the scientific literature. The common wisdom is that over prescribing antibiotics may result in increased morbidity and mortality from drug-resistant organisms. Society would apparently be better off if physicians restrain their use of the drugs reveal the authors. However, the effect of nonspecific mass antibiotic use on mortality has never before been assessed in a group-randomized clinical trial.

In an area in which residents have very limited access to antibiotics, mass distribution of oral azithromycin appears to reduce mortality in preschool children. Further assessment of the mechanism, generalizability, effects of drug resistance or other adverse outcomes, and cost-effectiveness of antibiotic administration in impoverished rural settings may be needed to provide further insight to guide public health policy.

This study was published in the issue of JAMA.