Azithromycin for child survival: digging without getting too dirty into the differential effect on cause-specific mortality

Abstract

A decade ago, the astonishing and unexpected results of a trachoma trial in Ethiopia1 hinted at the exciting potential of mass azithromycin distribution to significantly reduce all-cause mortality in children by approximately 50%. In 2018, the Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) multi-country study,2, 3 designed to investigate the effect of mass biannual azithromycin distribution on all-cause mortality in children aged 1–59 months in sub-Saharan African communities, corroborated these results—although with more modest and credible findings than the trachoma trial.1 The greatest reduction in all-cause mortality was observed in Niger, the site with the highest baseline mortality, where biannual mass distribution of azithromycin to children aged 1–59 months decreased all-cause mortality by 18% compared with placebo.