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.