title: Short-term malaria reduction by single-dose azithromycin during mass drug administration for trachoma, Tanzania.
abstract: Single-dose mass drug administration of azithromycin (AZT) is underway to eliminate trachoma worldwide. Studies in Ethiopia showed a reduction in all-cause childhood deaths after administration. To examine the effect of single-dose AZ MDA on prevalent malaria infections in a large prospective cohort of children and parents in Dodoma Province, Tanzania, we quantified the temporal prevalence of malaria parasitemia by real-time PCR for 6 months after single-dose AZT. In the first month after treatment but not in subsequent months, Plasmodium falciparum infections were reduced by 73% (95% CI 43%-89%) in treatment versus control villages and differences remained significant (p = 0.00497) in multivariate models with village-level random effects. Genetic sequencing of P. falciparum ribosomal L4 protein showed no mutations associated with AZT resistance. AZT mass drug administration caused a transient, 1-month antimalarial effect without selecting for P. falciparum ribosomal L4 resistance mutations in a region with a 10-year history of treating trachoma with this drug.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Schachterle
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Levens
authors.forename: Emily
authors.initials: E
authors.lastname: Clemens
authors.forename: Lirong
authors.initials: L
authors.lastname: Shi
authors.forename: Amrita
authors.initials: A
authors.lastname: Raj
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dumler
authors.forename: Beatriz
authors.initials: B
authors.lastname: Munoz
authors.forename: Shelia
authors.initials: S
authors.lastname: West
authors.forename: David J
authors.initials: DJ
authors.lastname: Sullivan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000187:drug effects / Q000254:growth & development; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D015800:Protozoan Proteins / Q000235:genetics*; D012269:Ribosomal Proteins / Q000235:genetics; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D015800:Protozoan Proteins; D012269:Ribosomal Proteins; D017963:Azithromycin
keywords: Tanzania; azithromycin; malaria; mass drug administration; parasites; prospective cohort study; single dose; trachoma