Twice-yearly azithromycin reduces all-cause mortality in countries at high risk for infant/childhood mortality (MORDOR II)

Reference

Keenan JD, Arzika AM, Maliki R, et al. Longer-term assessment of azithromycin for reducing childhood mortality in Africa. N Engl J Med 2019;380(23):2207-2214.

Synopsis

This Gates Foundation–funded study was the long-term follow-up to a study of malaria chemoprophylaxis in countries with a high burden of infant and childhood morbidity and mortality due to infectious diseases such as malaria and trachoma. The MORDOR I trial randomized villages in Niger, Malawi, and Tanzania to have all the village children between the ages of 1 month and 59 months receive either a single dose of azithromycin 20 mg/kg twice yearly or placebo. The study lasted 2 years, and childhood mortality was reduced by 14% in the villages in Malawi and Tanzania that received azithromycin, and by 18% in those villages in Niger. In the current trial (MORDOR II), children in the 594 participating Nigerien villages (n = 71,421) were all given twice yearly azithromycin during the third year (regardless of whether they had originally received azithromycin or placebo). Mortality was determined by house-to-house census in the participating villages. Thus, half of children were receiving their first year of chemoprophylaxis, and half their third year. Coverage with chemoprophylaxis was greater than 90%. The authors found similar mortality between children getting their first year or third year of chemoprophylaxis. One concern with the original study was that mortality may be delayed, but not prevented. However, the current study found no evidence that the mortality benefit waned in the third year.