In sub-Saharan Africa, nearly 10 percent of children die before reaching 5 years old, with around 2.8 million children dying in 2022 alone from diseases like pneumonia, diarrhea, and malaria that can be treated with antibiotics. Current recommendations only allow for antibiotics to be prescribed to infants between 1 and 11 months old to prevent the development of antibiotic resistance. However, a new study found that treating all children under 5 not only benefits older kids but also reduces mortality in infants.
A large trial conducted in 2018 showed that giving a single dose of azithromycin twice a year to children under 5 reduced mortality rates by almost 14 percent. This led to the World Health Organization’s current recommendation, which only included infants in the treatment. However, the researchers behind the new study had suspicions that the older children also needed to be treated to benefit the infants, leading to a follow-up trial in Niger involving over 380,000 children under 5 who were divided into different treatment groups.
Results published in the New England Journal of Medicine showed that treating all children under 5 reduced mortality rates for infants by 17 percent, demonstrating the indirect benefit of treating older children. The study authors, including epidemiologists Thomas Lietman and Kieran O’Brien from the University of California, San Francisco, believe that the majority of the antibiotic benefit is indirect rather than direct, highlighting the importance of community-wide treatment interventions.
The researchers were inspired to conduct the initial trial in 2018 by trachoma studies that found a reduction in childhood mortality rates in communities receiving widespread antibiotic treatment. Despite the quick guidelines issued by the WHO following the 2018 trial, there was some disappointment over the restricted age group for treatment. The recent AVENIR trial showed a reduction in mortality in the 1-to-11-month age group when they alone were treated, although the effect was not statistically significant.
The study results suggest that mass drug administration interventions have both direct effects on the children receiving treatment and indirect effects through community-wide reductions in disease transmission. The hope is that future guidelines will be updated to recommend treatment for all children under 5, with the necessary monitoring of resistance and considerations for managing the intervention over time. Ultimately, the goal is to reduce transmission enough to eliminate the future need for mass distribution of antibiotics, leading to sustained reductions in childhood mortality rates in the region.
