Trial reportThe Journal of infectious diseases2025
Impact of Macrolide Resistance on Azithromycin for Prevention of Rehospitalization or Death Among Children Discharged From Hospitals in Western Kenya.
Trial report in The Journal of infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02414399 (Azithromycin to Prevent Post-discharge Morbidity and Mortality in Kenyan Children), which is not on this map. Cited by 2 papers.
What it found
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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.
Azithromycin to Prevent Post-discharge Morbidity and Mortality in Kenyan Children
Who cites it
2 citing papers in PubMed.
- Impact of Azithromycin Administration at Hospital Discharge on Antimicrobial Resistance and Enteropathogen Carriage 3 Months Following Treatment.medRxiv : the preprint server for health sciences · 2026Article
- Genome-wide association studies builds a predictive model and reveals novel resistance features for macrolide-resistant Bordetella pertussis.The Journal of antimicrobial chemotherapy · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
backgroundThe Toto Bora trial tested whether a 5-day course of azithromycin reduced the risk of rehospitalization or death in the 6 months following hospitalization among Kenyan children and found no overall benefit. We hypothesized that macrolide resistance in gut microbes could modify azithromycin's effect.
methodsFrom June 2016 to November 2019, Kenyan children aged 1-59 months were enrolled at hospital discharge and randomized to azithromycin or placebo. DNA from fecal samples and Escherichia coli isolates was analyzed for common macrolide resistance genes. Cox proportional hazards regression models, including interaction terms between randomization arm and individual macrolide resistance genes, were used to analyze time to rehospitalization or death, with Bonferroni correction applied to account for multiple comparisons.
resultsAmong 1393 children tested, 94.7% had at least 1 macrolide resistance gene in their fecal DNA at hospital discharge, most commonly mph(A) (68.6% [955/1393]), followed by msr(D) (67.3% [937/1393]) and erm(B) (60.7% [846/1393]). Mef(A) (23.7% [330/1393]) was the only macrolide resistance gene that modified azithromycin's effect on rehospitalization or death (interaction P = .008). In children without the mef(A) gene, azithromycin reduced the hazard of rehospitalization or death by a third (hazard ratio [HR], 0.66 [95% confidence interval {CI}, .45-.99]) whereas among children with the mef(A) gene, there was a higher risk in those randomized to azithromycin (HR, 2.72 [95% CI, 1.21-6.09]). The effect size of azithromycin's impact on mortality and rehospitalization as separate outcomes in children with and without mef(A) were consistent but underpowered.
conclusionsMacrolide resistance in the gut microbiome may influence the efficacy of azithromycin in children discharged from the hospital. Clinical Trials Registration. NCT02414399.
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