Just published. @WHO guidelines for Mass drug administration of azithromycin for child survival 1/n apps.who.int/iris/bitstream… 
Work done along with @SouthAfricanASP and colleagues led by the late Dr Bhan. @ShereenBhan_GH
3 trials conducted in Africa demonstrated effectiveness of MDA-AZT for reduction of child mortality rates. Results were compelling enough for @WHO to review the evidence. AZT may impact mortality in countries with ⬆️U5MR by reducing diarrhoea, pneumonia and malaria 3/n
3 systematic reviews were done to synthesize the evidence relating to efficacy, antimicrobial resistance, adverse effects, dose-duration and potential mechanisms of action through which MDA-AZT may #reduce mortality. These are cited in the guidelines. 4/n
Risk vs benefit, preferences of target population, ethics, acceptability and feasibility of antibiotic use with no clinical indication for treatment were taken into consideration 5/n
Recommendation against universal implementation of MDA-AZT for preventing child deaths.Reasons: heterogeneity in the 3 trials,1 study was -ive, no reduction in ARI or malaria(endemic causes of U5MR), concerns about #AntimicrobialResistance and potential adverse effects in infants
Conditional recommendation for MDA-AZT limited to sub-Saharan Africa in very high mortality settings where known child survival interventions are concurrently strengthened and U5MR and AMR are continuous monitored.
Guidelines will be revised in 2-3 years as new evidence emerges 8/8
