Evidence map›Paper›PMID 41845058›Full record

Trial reportNature medicine2026

Mass azithromycin distribution and antibiotic resistance in the gut and nasopharynx: a cluster-randomized trial.

Thuy Doan, Daisy Yan, Ahmed M Arzika, Amza Abdou, Ramatou Maliki, Bawa Aichatou, Ismael Mamane Bello, Diallo Beidi, Nasser Galo, Naser Harouna and 18 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Nature medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04224987 (Azithromycine Pour la Vie Des Enfants au Niger - Implémentation et Recherche), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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.

NCT04224987 phase4completednot on this map

Azithromycine Pour la Vie Des Enfants au Niger - Implémentation et Recherche: Essai mortalité et résistance (Azithromycin for Child Survival in Niger: Mortality Trial and Resistance Trial)

TypeinterventionalSponsorUniversity of California, San FranciscoRan2020 to 2024Enrolled864,493ConditionsMortality, Resistance Bacterial, Child, OnlyArmsAzithromycin, Placebo
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
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

28 authors.

Thuy Doan *Francis I Proctor Foundation, University of California, San Francisco, CA, USA. thuy.doan@ucsf.edu.ORCID http://orcid.org/0000-0003-2733-8370
Daisy Yan *Francis I Proctor Foundation, University of California, San Francisco, CA, USA.
Ahmed M Arzika *Centre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Amza AbdouProgramme National de Santé Oculaire, Niamey, Niger.
Ramatou MalikiCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Bawa AichatouCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Ismael Mamane BelloCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Diallo BeidiCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Nasser GaloCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Naser HarounaCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Alio M KarambaCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Sani MahamadouCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Moustapha AbarchiCentre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.
Almou IbrahimProgramme National de Santé Oculaire, Niamey, Niger.
Lina ZhongFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Cindi ChenFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
YuHeng LiuFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Danny YuFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Thomas AbrahamFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Angela S ChengFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Brittany PetersonFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Catherine E OldenburgFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Travis C PorcoFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Benjamin F ArnoldFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0001-6105-7295
Armin HinterwirthFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0001-6450-488X
Elodie LebasFrancis I Proctor Foundation, University of California, San Francisco, CA, USA.
Kieran S O'BrienFrancis I Proctor Foundation, University of California, San Francisco, CA, USA. Kieran.Obrien@ucsf.edu.ORCID http://orcid.org/0000-0002-1962-5321
Thomas M LietmanFrancis I Proctor Foundation, University of California, San Francisco, CA, USA. Tom.Lietman@ucsf.edu.ORCID http://orcid.org/0000-0001-8216-0240

Funding

Résistance Evaluée contre la Vie des Enfants au Niger-Implementation et Recherche (REVENIR). Community antimicrobial resistance after azithromycin distribution: selection, spillover, co-selectionR01AI175250 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI THOMAS M LIETMAN, Kieran O'Brien · 2024 to 2026
$2.3M
NIAID NIH HHS R01 AI175250
6 · The paper itself

Abstract

Repeated semiannual azithromycin mass drug administration (MDA) to children has been shown to reduce all-cause childhood mortality. However, antibiotic resistance is a major public health concern as the program is being implemented in sub-Saharan Africa. In the double-blind, cluster-randomized, placebo-controlled trial (AVENIR) in Niger, we evaluated the impact of azithromycin MDA targeting different age groups on mortality and on the gut and nasopharyngeal microbiome and resistome of children in participating communities. A total of 3,000 communities were randomized in a 1:1:1 allocation to 3 arms: 2 years of semiannual MDA of (1: child-azithromycin) azithromycin to 1-59-month olds, (2: infant-azithromycin) azithromycin to 1-11-month olds and placebo to 12-59-month olds or (3: placebo) placebo to 1-59-month olds. Mortality (co-primary endpoint) and safety data have previously been published. Here we report on resistance (the co-primary endpoint). One hundred fifty communities (50 per arm) were selected for this analysis. A total of 4,382 rectal and 4,402 nasopharyngeal samples were included. The co-primary outcomes included changes in gut and nasopharynx macrolide AMR. The trial met its primary AMR endpoint for the gut but not for the nasopharynx. The gut macrolide AMR burden in fold change between arms was highest in child-azithromycin compared with placebo (1.16, 95% confidence interval (CI): 1.06-1.28; P < 0.01), followed by child-azithromycin compared with infant-azithromycin (1.13, 95% CI: 1.02-1.23; P = 0.01), and infant-azithromycin compared with placebo (1.04×, 95% CI: 0.94-1.15×; P = 0.66). There were no statistically significant differences in macrolide AMR selection fold change in the nasopharynx between arms: 2.14 (95% CI: 0.93-4.99) for child-azithromycin versus placebo, 2.08 (95% CI: 0.93-4.69) for infant-azithromycin versus placebo, and 1.03 (95% CI: 0.46-2.30) for child-azithromycin versus infant-azithromycin. Close monitoring of AMR should be an essential component of MDA for childhood mortality. ClinicalTrials.gov registration: NCT04224987.

Indexed as

Anti-Bacterial AgentsAzithromycinDrug Resistance, BacterialDrug Resistance, MicrobialMass Drug AdministrationNasopharynxChild, PreschoolDouble-Blind MethodFemaleHumansInfantMaleNigerAnti-Bacterial AgentsAzithromycin

Identifiers

PMID41845058
PMCPMC13004693

What OpenQuestion holds

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LicenceCC BY
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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.