A recent study, the "Azithromycine pour la Vie des Enfants au Niger: Implementation et Recherche" (AVENIR) trial in Niger, has demonstrated that mass distribution of azithromycin can significantly reduce overall child mortality rates. The research, presented by Dr. Thomas Lietman, builds upon previous findings from the MORDOR trial, which showed similar benefits in children aged 1-59 months across Niger, Tanzania, and Malawi.
The AVENIR trial aimed to re-test whether mass azithromycin distribution reduced childhood mortality in 1-59 month-olds and compared the reduction in mortality when treating only 1-11 month-olds as opposed to 1-59 month-olds. The study also monitored antibiotic resistance.
The results indicated that children aged 1-11 months experienced significantly better outcomes when the older children (1-59 months) also received azithromycin. This suggests a herd effect, where treating older children indirectly benefits younger, more vulnerable children. The researchers successfully adapted toward the 1-59 month-old treatment group after 12 months, using a tempering algorithm to avoid dramatic swings in allocation probabilities.
Furthermore, the study revealed that trachoma distributions and the childhood mortality distributions do select for macrolide resistance in a number of different bacteria, with resistance decreasing when the programs are stopped. Since they are only treating 1/6 of a population, there is less antibiotic pressure than with trachoma programs that treat an entire community.
Ethical considerations were paramount throughout the trial, including obtaining informed consent and ensuring post-trial availability of treatment. Strong local collaborations were crucial, avoiding the imposition of Western academic perspectives.
Looking ahead, the AVENIR 2 trial will expand the AVENIR study to the entire country of Niger. This expansion aims to further refine treatment strategies and monitor the long-term impact of mass azithromycin distribution on childhood mortality and antibiotic resistance.
