Evidence map›Paper›PMID 36253018›Full record

ArticleBMJ global health2022

Simplified dosing of oral azithromycin for children 1-11 months old in child survival programmes: age-based and height-based dosing protocols.

Huiyu Hu, Ahmed Mamane Arzika, Ali Sie, Amza Abdou, Ramatou Maliki, Alio Karamba Mankara, Mamadou Outtara, Mamadou Bountogo, Valentin Boudo, Fanny Yago-Wienne and 10 more

Abstract read
In one paragraph

Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Huiyu HuFrancis I. Proctor Foundation, University of California, San Francisco, California, USA.
Ahmed Mamane ArzikaCentre de Recherche et Interventions en Sante Publique, Niamey, Niger.
Ali SieCentre de Recherche en Sante de Nouna, Nouna, Burkina Faso.
Amza AbdouProgramme Nationale de Santé Oculaire, Niamey, Niger.
Ramatou MalikiCentre de Recherche et Interventions en Sante Publique, Niamey, Niger.
Alio Karamba MankaraCentre de Recherche et Interventions en Sante Publique, Niamey, Niger.
Mamadou OuttaraCentre de Recherche en Sante de Nouna, Nouna, Burkina Faso.
Mamadou BountogoCentre de Recherche en Sante de Nouna, Nouna, Burkina Faso.
Valentin BoudoCentre de Recherche en Sante de Nouna, Nouna, Burkina Faso.
Fanny Yago-WienneHelen Keller International, Ouagadougou, Burkina Faso.
Issouf BambaHelen Keller International, Ouagadougou, Burkina Faso.
Charles KnirschPfizer Inc, New York, New York, USA.
Paul EmersonInternational Trachoma Initiative, Decatur, Georgia, USA.
P J HooperInternational Trachoma Initiative, Decatur, Georgia, USA.
Elodie LebasFrancis I. Proctor Foundation, University of California, San Francisco, California, USA.
Jessica BrogdonFrancis I. Proctor Foundation, University of California, San Francisco, California, USA.
Fanice NyatigoFrancis I. Proctor Foundation, University of California, San Francisco, California, USA.
Catherine E OldenburgFrancis I. Proctor Foundation, University of California, San Francisco, California, USA.ORCID 0000-0002-0763-399X
Thomas M LietmanFrancis I. Proctor Foundation, University of California, San Francisco, California, USA.
Kieran S O'BrienFrancis I. Proctor Foundation, University of California, San Francisco, California, USA kieran.obrien@ucsf.edu.ORCID 0000-0002-1962-5321

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo facilitate mass distribution of azithromycin, trachoma control programmes use height instead of weight to determine dose for children 6 months to 15 years old. WHO has recommended azithromycin distribution to children 1-11 months old to reduce mortality in high mortality settings under carefully monitored conditions. Weight was used to determine dose in children 1-5 months old in studies of azithromycin distribution for child survival, but a simplified approach using age or height for all aged 1-11 months old could increase programme efficiency in real-world settings.

methodsThis secondary analysis used data from two cluster randomised trials of azithromycin distribution for child mortality in Niger and Burkina Faso. An exhaustive search algorithm was developed to determine the optimal dose for different age groups, using tolerance limits of 10-20 mg/kg for children 1-2 months old and 15-30 mg/kg for children 3-11 months old. Height-based dosing was evaluated against the existing trachoma dosing pole and with a similar exhaustive search.

resultsThe optimal two-tiered age-based approach suggested a dose of 80 mg (2 mL) for children 1-2 months old and 160 mg (4 mL) for children 3-11 months old. Under this schedule, 89%-93% of children would have received doses within tolerance limits in both study populations. Accuracy was 93%-94% with a three-tiered approach, which resulted in doses of 80 mg (2 mL), 120 mg (3 mL) and 160 mg (4 mL) for children 1-2, 3-4 and 5-11 months old, respectively. For children 1-5 months old, the existing height pole would result in 70% of doses within tolerance limits. The optimisation identified height-based dosing options with 95% accuracy, although this would require changes to the existing dosing pole as well as additional training to measure infants lying flat.

conclusionsOverall, an age-based approach with two age tiers resulted in high accuracy while considering both concerns about overdosing in this young population and simplicity of field operations.

Indexed as

AzithromycinTrachomaAnti-Bacterial AgentsBody HeightChildChild MortalityHumansInfantAnti-Bacterial AgentsAzithromycinchild healthpublic health

Identifiers

PMID36253018
PMCPMC9577904

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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.