title: Gut Microbial Diversity in Antibiotic-Naive Children After Systemic Antibiotic Exposure: A Randomized Controlled Trial.
abstract: Antibiotic exposure can alter the gut microbiome. We evaluate the effects of azithromycin on the gut microbiome diversity of children from an antibiotic-naive community in Niger.
  
  
  
  A population-based sample of 80 children aged 1-60 months in the Dosso region of Niger was randomized to receive a single dose of either oral azithromycin or placebo. Fecal samples were collected immediately before treatment and 5 days after treatment for 16S rRNA gene sequencing. The prespecified outcome was α-diversity (inverse Simpson's α-diversity index), with secondary outcomes of β and γ Simpson's and Shannon's diversities.
  
  
  
  At 5 days after treatment, 40 children aged 1-60 months were analyzed in the azithromycin-treated group and 40 children in the placebo-treated group. Diversity of the gut microbiome was significantly lower in the treated group (inverse Simpson's α-diversity, 5.03; 95% confidence interval [CI], 4.08-6.14) than in the placebo group (6.91; 95% CI, 5.82-8.21; P = .03). Similarly, the Shannon's α-diversity was lower in the treated group (10.60; 95% CI, 8.82-12.36) than the placebo group (15.42; 95% CI, 13.24-17.80; P = .004). Simpson's community-level (γ) diversity decreased with azithromycin exposure from 17.72 (95% CI, 13.80-20.21) to 10.10 (95% CI, 7.80-11.40; P = .00008), although β-diversity was not significantly reduced (2.56, 95% CI, 1.88-3.12; to 2.01, 95% CI, 1.46-2.51; P = .26).
  
  
  
  Oral administration of azithromycin definitively decreases the diversity of the gut microbiome of children in an antibiotic-naive community.
  
  
  
  NCT02048007.
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.|Department of Ophthalmology, University of California, San Francisco, California, United States of America.
authors.forename: Thuy
authors.initials: T
authors.lastname: Doan
authors.affiliation: The Carter Center Niger, Republique du Niger.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Arzika
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ray
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Sun Y
authors.initials: SY
authors.lastname: Cotter
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kim
authors.affiliation: The Carter Center Niger, Republique du Niger.
authors.forename: Ramatou
authors.initials: R
authors.lastname: Maliki
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Lina
authors.initials: L
authors.lastname: Zhong
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.|Department of Ophthalmology, University of California, San Francisco, California, United States of America.|Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America.
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Vanderschelden
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.|Department of Ophthalmology, University of California, San Francisco, California, United States of America.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.|Department of Ophthalmology, University of California, San Francisco, California, United States of America.|Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America.|Medical Sciences, University of California-San Francisco, San Francisco, California, United States of America.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D044822:Biodiversity; D002675:Child, Preschool; D016000:Cluster Analysis; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008297:Male; D009548:Niger; D010802:Phylogeny; D010919:Placebos / Q000008:administration & dosage; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA
chemical_list: D000900:Anti-Bacterial Agents; D004275:DNA, Ribosomal; D010919:Placebos; D012336:RNA, Ribosomal, 16S; D017963:Azithromycin
keywords: antibiotics.; azithromycin; children; gut microbiome; randomized controlled trial