Short-term malaria reduction by single-dose azithromycin during mass drug administration for trachoma, Tanzania

• Published in: Emerging infectious diseases Vol. 20; no. 6; pp. 941 - 949
• Main Authors: Schachterle, Stephen E, Mtove, George, Levens, Joshua P, Clemens, Emily, Shi, Lirong, Raj, Amrita, Dumler, J Stephen, Munoz, Beatriz, West, Shelia, Sullivan, David J
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01-06-2014; Centers for Disease Control and Prevention
• Subjects: Anti-Bacterial Agents - therapeutic use; Azithromycin; Azithromycin - therapeutic use; Child; Child, Preschool; Chlamydia trachomatis - drug effects; Chlamydia trachomatis - growth & development; Dosage and administration; Drug Administration Schedule; Female; Health aspects; Humans; Infant; Infection; Malaria; Malaria, Falciparum - drug therapy; Malaria, Falciparum - epidemiology; Malaria, Falciparum - parasitology; Male; mass drug administration; parasites; Plasmodium falciparum; Plasmodium falciparum - drug effects; Plasmodium falciparum - genetics; Plasmodium falciparum - growth & development; prospective cohort study; Protozoan Proteins - genetics; Ribosomal Proteins - genetics; Tanzania - epidemiology; Time Factors; Trachoma; Trachoma - drug therapy; Trachoma - epidemiology; Trachoma - microbiology; Tanzania; Ethiopia; trachoma; mass drug administration; prospective cohort study; Tanzania; parasites; azithromycin; malaria; single dose
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2006.131302

Single-dose mass drug administration of azithromycin (AZT) is underway to eliminate trachoma worldwide. Studies in Ethiopia showed a reduction in all-cause childhood deaths after administration. To examine the effect of single-dose AZ MDA on prevalent malaria infections in a large prospective cohort of children and parents in Dodoma Province, Tanzania, we quantified the temporal prevalence of malaria parasitemia by real-time PCR for 6 months after single-dose AZT. In the first month after treatment but not in subsequent months, Plasmodium falciparum infections were reduced by 73% (95% CI 43%-89%) in treatment versus control villages and differences remained significant (p = 0.00497) in multivariate models with village-level random effects. Genetic sequencing of P. falciparum ribosomal L4 protein showed no mutations associated with AZT resistance. AZT mass drug administration caused a transient, 1-month antimalarial effect without selecting for P. falciparum ribosomal L4 resistance mutations in a region with a 10-year history of treating trachoma with this drug.