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Azithromycin for Bacterial Watery Diarrhea: A Reanalysis of the AntiBiotics for Children With Severe Diarrhea (ABCD) Trial Incorporating Molecular Diagnostics.
Pavlinac, Patricia B; Platts-Mills, James A; Liu, Jie; Atlas, Hannah E; Gratz, Jean; Operario, Darwin; Rogawski McQuade, Elizabeth T; Ahmed, Dilruba; Ahmed, Tahmeed; Alam, Tahmina; Ashorn, Per; Badji, Henry; Bahl, Rajiv; Bar-Zeev, Naor; Chisti, Mohammod Jobayer; Cornick, Jen; Chauhan, Aishwarya; De Costa, Ayesha; Deb, Saikat; Dhingra, Usha; Dube, Queen; Duggan, Christopher P; Freyne, Bridget; Gumbi, Wilson; Hotwani, Aneeta; Kabir, Mamun; Islam, Ohedul; Kabir, Furqan; Kasumba, Irene; Kibwana, Upendo; Kotloff, Karen L; Khan, Shaila S; Maiden, Victor; Manji, Karim; Mehta, Ashka; Ndeketa, Latif; Praharaj, Ira; Qamar, Farah Naz; Sazawal, Sunil; Simon, Jonathon; Singa, Benson O; Somji, Sarah; Sow, Samba O; Tapia, Milagritos D; Tigoi, Caroline; Toure, Aliou; Walson, Judd L; Yousafzai, Mohammad Tahir; Houpt, Eric R.
Afiliación
  • Pavlinac PB; Department of Global Health.
  • Platts-Mills JA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
  • Liu J; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
  • Atlas HE; School of Public Health, Qingdao University, Qingdao, China.
  • Gratz J; Department of Global Health.
  • Operario D; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
  • Rogawski McQuade ET; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
  • Ahmed D; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
  • Ahmed T; Laboratory Sciences and Services Division.
  • Alam T; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
  • Ashorn P; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
  • Badji H; Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.
  • Bahl R; Centre pour le Développement des Vaccines, Bamako, Mali.
  • Bar-Zeev N; Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland.
  • Chisti MJ; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Cornick J; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
  • Chauhan A; Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi.
  • De Costa A; Center for Public Health Kinetics, New Delhi, India.
  • Deb S; Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland.
  • Dhingra U; Center for Public Health Kinetics, New Delhi, India.
  • Dube Q; Center for Public Health Kinetics, New Delhi, India.
  • Duggan CP; Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.
  • Freyne B; Division of Gastroenterology, Hepatology and Nutrition, Department of Nutrition, Boston Children's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Gumbi W; Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi.
  • Hotwani A; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Kabir M; Department of Women and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.
  • Islam O; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
  • Kabir F; Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
  • Kasumba I; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
  • Kibwana U; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
  • Kotloff KL; Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
  • Khan SS; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Maiden V; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Manji K; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Mehta A; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Ndeketa L; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
  • Praharaj I; Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi.
  • Qamar FN; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Sazawal S; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Simon J; Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi.
  • Singa BO; Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
  • Somji S; Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
  • Sow SO; Center for Public Health Kinetics, New Delhi, India.
  • Tapia MD; Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland.
  • Tigoi C; Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
  • Toure A; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Walson JL; Centre pour le Développement des Vaccines, Bamako, Mali.
  • Yousafzai MT; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Houpt ER; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
J Infect Dis ; 229(4): 988-998, 2024 Apr 12.
Article en En | MEDLINE | ID: mdl-37405406
BACKGROUND: Bacterial pathogens cause substantial diarrhea morbidity and mortality among children living in endemic settings, yet antimicrobial treatment is only recommended for dysentery or suspected cholera. METHODS: AntiBiotics for Children with severe Diarrhea was a 7-country, placebo-controlled, double-blind efficacy trial of azithromycin in children 2-23 months of age with watery diarrhea accompanied by dehydration or malnutrition. We tested fecal samples for enteric pathogens utilizing quantitative polymerase chain reaction to identify likely and possible bacterial etiologies and employed pathogen-specific cutoffs based on genomic target quantity in previous case-control diarrhea etiology studies to identify likely and possible bacterial etiologies. RESULTS: Among 6692 children, the leading likely etiologies were rotavirus (21.1%), enterotoxigenic Escherichia coli encoding heat-stable toxin (13.3%), Shigella (12.6%), and Cryptosporidium (9.6%). More than one-quarter (1894 [28.3%]) had a likely and 1153 (17.3%) a possible bacterial etiology. Day 3 diarrhea was less common in those randomized to azithromycin versus placebo among children with a likely bacterial etiology (risk difference [RD]likely, -11.6 [95% confidence interval {CI}, -15.6 to -7.6]) and possible bacterial etiology (RDpossible, -8.7 [95% CI, -13.0 to -4.4]) but not in other children (RDunlikely, -0.3% [95% CI, -2.9% to 2.3%]). A similar association was observed for 90-day hospitalization or death (RDlikely, -3.1 [95% CI, -5.3 to -1.0]; RDpossible, -2.3 [95% CI, -4.5 to -.01]; RDunlikely, -0.6 [95% CI, -1.9 to .6]). The magnitude of risk differences was similar among specific likely bacterial etiologies, including Shigella. CONCLUSIONS: Acute watery diarrhea confirmed or presumed to be of bacterial etiology may benefit from azithromycin treatment. CLINICAL TRIALS REGISTRATION: NCT03130114.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Shigella / Infecciones Bacterianas / Criptosporidiosis / Cryptosporidium / Disentería Tipo de estudio: Clinical_trials / Diagnostic_studies Límite: Child / Humans / Infant Idioma: En Revista: J Infect Dis Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Shigella / Infecciones Bacterianas / Criptosporidiosis / Cryptosporidium / Disentería Tipo de estudio: Clinical_trials / Diagnostic_studies Límite: Child / Humans / Infant Idioma: En Revista: J Infect Dis Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos