Trial reportPLoS medicine2010
Antibiotic selection pressure and macrolide resistance in nasopharyngeal Streptococcus pneumoniae: a cluster-randomized clinical trial.
Trial report in PLoS medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00322972 (Eliminating Trachoma With Repeat Mass Drug Treatment), which is not on this map. Cited by 85 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Eliminating Trachoma With Repeat Mass Drug Treatment
Who cites it
85 citing papers in PubMed, 6 syntheses or guidelines pooled it, 139 citations in OpenAlex.
- β-Lactam-Resistant Streptococcus pneumoniae Dynamics Following Treatment: A Dose-Response Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Pooled it
- Secondary Effects from Mass Azithromycin Administration: A Systematic Review and Meta-analysis.The American journal of tropical medicine and hygiene · 2022Pooled it
- Antibiotics for trachoma.The Cochrane database of systematic reviews · 2019Pooled it
- Mass Azithromycin Distribution to Prevent Childhood Mortality: A Pooled Analysis of Cluster-Randomized Trials.The American journal of tropical medicine and hygiene · 2019Pooled it
- Resistance decay in individuals after antibiotic exposure in primary care: a systematic review and meta-analysis.BMC medicine · 2018Pooled it
- Pooled it
- Targeted Mass Azithromycin Distribution for Trachoma: A Community-Randomized Trial (TANA II).Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Effect of Biannual Mass Azithromycin Distributions to Preschool-Aged Children on Trachoma Prevalence in Niger: A Cluster Randomized Clinical Trial.JAMA network open · 2022Trial
- Prevalence of nasopharyngealThe Lancet. Microbe · 2022Trial
- Azithromycin for the prevention of rehospitalisation and death among Kenyan children being discharged from hospital: a double-blind, placebo-controlled, randomised controlled trial.The Lancet. Global health · 2021Trial
- Effect of Once-Weekly Azithromycin vs Placebo in Children With HIV-Associated Chronic Lung Disease: The BREATHE Randomized Clinical Trial.JAMA network open · 2020Trial
- Frequency of Mass Azithromycin Distribution for Ocular Chlamydia in a Trachoma Endemic Region of Ethiopia: A Cluster Randomized Trial.American journal of ophthalmology · 2020Trial
- Linear growth in preschool children treated with mass azithromycin distributions for trachoma: A cluster-randomized trial.PLoS neglected tropical diseases · 2019Trial
- Randomized Trial of Community Treatment With Azithromycin and Ivermectin Mass Drug Administration for Control of Scabies and Impetigo.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Trial
- Epidemiological characteristics of nasopharyngeal Streptococcus pneumoniae strains among children with pneumonia in Chongqing, China.Scientific reports · 2019Trial
- Long-term Impact of Oral Azithromycin Taken by Gambian Women During Labor on Prevalence and Antibiotic Susceptibility of Streptococcus pneumoniae and Staphylococcus aureus in Their Infants: Follow-up of a Randomized Clinical Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Trial
- Impact of Antimicrobial Treatment for Acute Otitis Media on Carriage Dynamics of Penicillin-Susceptible and Penicillin-Nonsusceptible Streptococcus pneumoniae.The Journal of infectious diseases · 2018Trial
- Mass azithromycin distribution for hyperendemic trachoma following a cluster-randomized trial: A continuation study of randomly reassigned subclusters (TANA II).PLoS medicine · 2018Trial
- Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa.The New England journal of medicine · 2018Trial
- Comparison of Mass Azithromycin Coverage Targets of Children in Niger: A Cluster-Randomized Trachoma Trial.The American journal of tropical medicine and hygiene · 2018Trial
25 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundIt is widely thought that widespread antibiotic use selects for community antibiotic resistance, though this has been difficult to prove in the setting of a community-randomized clinical trial. In this study, we used a randomized clinical trial design to assess whether macrolide resistance was higher in communities treated with mass azithromycin for trachoma, compared to untreated control communities. METHODS AND
findingsIn a cluster-randomized trial for trachoma control in Ethiopia, 12 communities were randomized to receive mass azithromycin treatment of children aged 1-10 years at months 0, 3, 6, and 9. Twelve control communities were randomized to receive no antibiotic treatments until the conclusion of the study. Nasopharyngeal swabs were collected from randomly selected children in the treated group at baseline and month 12, and in the control group at month 12. Antibiotic susceptibility testing was performed on Streptococcus pneumoniae isolated from the swabs using Etest strips. In the treated group, the mean prevalence of azithromycin resistance among all monitored children increased from 3.6% (95% confidence interval [CI] 0.8%-8.9%) at baseline, to 46.9% (37.5%-57.5%) at month 12 (p = 0.003). In control communities, azithromycin resistance was 9.2% (95% CI 6.7%-13.3%) at month 12, significantly lower than the treated group (p < 0.0001). Penicillin resistance was identified in 0.8% (95% CI 0%-4.2%) of isolates in the control group at 1 year, and in no isolates in the children-treated group at baseline or 1 year.
conclusionsThis cluster-randomized clinical trial demonstrated that compared to untreated control communities, nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities randomized to intensive azithromycin treatment. Mass azithromycin distributions were given more frequently than currently recommended by the World Health Organization's trachoma program. Azithromycin use in this setting did not select for resistance to penicillins, which remain the drug of choice for pneumococcal infections.
trial registrationwww.ClinicalTrials.gov NCT00322972. Please see later in the article for the Editors' Summary.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.