Longer-Term Assessment of Azithromycin for Reducing Childhood Mortality in Africa

By Jeremy D. Keenan, M.D., Ahmed M. Arzika, M.S., Ramatou Maliki, M.S., Nameywa Boubacar, M.D., Sanoussi Elh Adamou, M.D., Maria Moussa Ali, M.P.H., Catherine Cook, M.P.H., Elodie Lebas, R.N., Ying Lin, M.P.H., Kathryn J. Ray, Ph.D., Kieran S. O’Brien, M.P.H., Thuy Doan, M.D., Ph.D., Catherine E. Oldenburg, Sc.D., M.P.H., E. Kelly Callahan, M.P.H., Paul M. Emerson, Ph.D., Travis C. Porco, Ph.D., M.P.H., and Thomas M. Lietman, M.D.

The New England Journal of Medicine, June 6, 2019


The MORDOR I trial (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) showed that in Niger, mass administration of azithromycin twice a year for 2 years resulted in 18% lower postneonatal childhood mortality than administration of placebo. Whether this benefit could increase with each administration or wane owing to antibiotic resistance was unknown.

In the Niger component of the MORDOR I trial, we randomly assigned 594 communities to four twice-yearly distributions of either azithromycin or placebo to children 1 to 59 months of age. In MORDOR II, all these communities received two additional open-label azithromycin distributions. All-cause mortality was assessed twice yearly by census workers who were unaware of participants’ original assignments.

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Does a Diagnosis of Community-Acquired Pneumonia in a Child Always Require Antibiotics?

By Miles Weinberger

JAMA Pediatrics, June 3, 2019


“To the Editor This letter is in response to the Tribble et al article, “Comparison of Antibiotic Prescribing for Pediatric Community-Acquired Pneumonia in Children’s and Non-Children’s Hospitals,”1 published online December 10, 2018.

Tribble et al1 determined that physicians at children’s hospitals provided guideline-recommended treatment for community-acquired pneumonia (CAP) more frequently than physicians at non-children’s hospitals. They report that the guidelines indicate that hospitalized children with CAP should be treated with penicillin, amoxicillin, or ampicillin. However, there is evidence that that there is frequently overdiagnosis and overtreatment of CAP resulting from those recommendations.”

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Risks Related to the Use of Non-Steroidal Anti-Inflammatory Drugs in Community-Acquired Pneumonia in Adult and Pediatric Patients

By Guillaume Voiriot, Quentin Philippot, Alexandre Elabbadi, Carole Elbim, Martin Chalumeau and Muriel Fartoukh

Journal of Clinical Medicine, June 3, 2019


Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate symptoms during community-acquired pneumonia (CAP), while neither clinical data nor guidelines encourage this use. Experimental data suggest that NSAIDs impair neutrophil intrinsic functions, their recruitment to the inflammatory site, and the resolution of inflammatory processes after acute pulmonary bacterial challenge. During CAP, numerous observational data collected in hospitalized children, hospitalized adults, and adults admitted to intensive care units (ICUs) support a strong association between pre-hospital NSAID exposure and a delayed hospital referral, a delayed administration of antibiotic therapy, and the occurrence of pleuropulmonary complications, even in the only study that has accounted for a protopathic bias. Other endpoints have been described including a longer duration of antibiotic therapy and a greater hospital length of stay. In all adult series, patients exposed to NSAIDs were younger and had fewer comorbidities. The mechanisms by which NSAID use would entail a complicated course in pneumonia still remain uncertain. The temporal hypothesis and the immunological hypothesis are the two main emerging hypotheses. Current data strongly support an association between NSAID intake during the outpatient treatment of CAP and a complicated course. This should encourage experts and scientific societies to strongly advise against the use of NSAIDs in the management of lower respiratory tract infections.

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Monitoring and Evaluation of the Global Action Plan on Antimicrobial Resistance Framework and Recommended Indicators

By: World Health Organization, May 2019


Robust monitoring and evaluation are needed in order to measure progress towards the delivery of the global action plan on antimicrobial resistance (GAP) objectives, and help identify key achievements and persisting gaps across human, animal, plant, food, and environment sectors in efforts to tackle antimicrobial resistance (AMR).

The Tripartite have co-developed a monitoring and evaluation (M&E) framework for the GAP, which aims to generate data to assess the delivery of GAP objectives, and inform operational and strategic decision making on AMR for the next five years. The framework includes two parallel tracks of M&E activities. Track 1 focuses on the inputs, activities, and outputs of the GAP. It is designed to monitor the progress of different stakeholders in implementing the GAP, and to evaluate how to improve the collective response. Track 2 focuses on GAP outcomes and impact goals. It is designed to assess the effectiveness of GAP implementation efforts, including monitoring their results, and evaluating their impact on, for example, AMR, appropriate use of antimicrobials, and burden of disease.

The framework includes recommended core indicators that have been agreed across the Tripartite, including UNEP, which needs to be collected and monitored at national, regional, and global levels. There was significant consultations over two years with governments, experts, academia, civil society and the public to help develop the list of indicators to be monitored. The framework also includes country level evaluations, monitoring of research and development, and a proposed global-level independent evaluation. The applicability of this framework will initially be tested in a few targeted countries; the framework will be refined periodically based on lessons learnt during its implementation over the next 3-5 years. The Framework and the indicators are expected to guide and support the development of relevant AMR monitoring systems in countries, help produce data for monitoring progress at the national and global level, and support strategic decision making.

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Dose, Timing, and Type of Infant Antibiotic Use and the Risk of Childhood Asthma

By Brittney M Donovan, Andrew Abreo, Tan Ding, Tebeb Gebretsadik, Kedir N Turi, Chang Yu, Juan Ding  William D Dupont, Cosby A Stone, Tina V Hartert, Pingsheng Wu

Clinical Infectious Diseases, May 31, 2019


Aspects of infant antibiotic exposure and its association with asthma development have been variably explored. We aimed to evaluate comprehensively and simultaneously the impact of dose, timing, and type of infant antibiotic use on the risk of childhood asthma.

Singleton, term birth, non-low birth weight, and otherwise healthy children enrolled in the Tennessee Medicaid Program were included. Infant antibiotic use and childhood asthma diagnosis were ascertained from prescription fills and healthcare encounter claims. We examined the association using multivariable logistic regression models.

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