title: Chloroquine-azithromycin combination antimalarial treatment decreases risk of respiratory- and gastrointestinal-tract infections in Malawian children.
abstract: BACKGROUND
  Chloroquine-azithromycin is being evaluated as combination therapy for malaria. It may provide added benefit in treating or preventing bacterial infections that occur in children with malaria.
  
  
  OBJECTIVE
  We aim to evaluate the effect of treating clinical malaria with chloroquine-azithromycin on the incidence of respiratory-tract and gastrointestinal-tract infections compared to treatment with chloroquine monotherapy.
  
  
  METHODS
  We compared the incidence density and time to first events of respiratory-tract and gastrointestinal-tract infections among children assigned to receive chloroquine-azithromycin or chloroquine for all symptomatic malaria episodes over the course of 1 year in a randomized longitudinal trial in Blantyre, Malawi.
  
  
  RESULTS
  The incidence density ratios of total respiratory-tract infections and gastrointestinal-tract infections comparing chloroquine-azithromycin to chloroquine monotherapy were 0.67 (95% confidence interval [CI], .48, .94) and 0.74 (95% CI, .55, .99), respectively. The time to first lower-respiratory-tract and gastrointestinal-tract infections were significantly longer in the chloroquine-azithromycin arm compared to the chloroquine arm (P = .04 and P = .02, respectively).
  
  
  CONCLUSIONS
  Children treated routinely with chloroquine-azithromycin had fewer respiratory and gastrointestinal-tract infections than those treated with chloroquine alone. This antimalarial combination has the potential to reduce the burden of bacterial infections among children in malaria-endemic countries.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gilliams
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine.
authors.forename: Jibreel
authors.initials: J
authors.lastname: Jumare
authors.affiliation: Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Cassidy W
authors.initials: CW
authors.lastname: Claassen
authors.affiliation: Blantyre Malaria Project, University of Malawi College of Medicine.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Thesing
authors.affiliation: Blantyre Malaria Project, University of Malawi College of Medicine.
authors.forename: Osward M
authors.initials: OM
authors.lastname: Nyirenda
authors.affiliation: Department of Pharmacy, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Fraction K
authors.initials: FK
authors.lastname: Dzinjalamala
authors.affiliation: Blantyre Malaria Project, University of Malawi College of Medicine Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, E. Lansing, Michigan.
authors.forename: Terrie
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Plowe
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine.
authors.forename: LaRee A
authors.initials: LA
authors.lastname: Tracy
authors.affiliation: Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Miriam K
authors.initials: MK
authors.lastname: Laufer
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D012306:Risk
chemical_list: D000962:Antimalarials; D017963:Azithromycin; D002738:Chloroquine
keywords: Malawi; azithromycin; chloroquine; gastrointestinal tract infection; malaria treatment; respiratory tract infection; secondary benefit