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for people ages 1 month and up
Healthy Volunteers
healthy people welcome
at San Francisco, California and other locations
study started
estimated completion:
Principal Investigator
Tom M Lietman



The long-term goal of this study is to more precisely define the role of mass azithromycin treatments as an intervention for reducing childhood morbidity and increasing growth, and for the potential selection of antibiotic resistance. The investigators propose a set of 3 cluster-randomized trials comparing communities randomized to oral azithromycin with those randomized to placebo. To assess the generalizability of the intervention, investigators will monitor for antibiotic resistance, which could potentially limit adoption of mass antibiotic treatments. The investigators will also assess several measures of infectious diseases. The investigators hypothesize that mass azithromycin treatments will reduce childhood morbidity and will be accompanied by an acceptable level of antibiotic resistance.

Official Title

Evaluating Impact of Azithromycin Mass Drug Administrations on Cause-specific Mortality and Antibiotic Resistance: Morbidity Study


The investigators will assess childhood infectious disease morbidity and macrolide resistance over two years, comparing communities where children aged 1-60 months receive biannual oral azithromycin to communities where the children receive biannual oral placebo. In Niger, a third arm - annual treatment of all persons 1 month and older - will also be included.

Randomization of Treatment Allocation. In each site, 30 communities within a contiguous area of 300,000 to 600,000 individuals will be randomized into the azithromycin or placebo arm. At the Niger site, an additional 15 communities will be randomized to the third arm (azithromycin for everyone). The investigators will use a simple random sample separately for each study site, but without stratification or block randomization within the site. These communities are being randomized from the same pool of communities eligible for a sister trial (Mortality Reduction After Oral Azithromycin (MORDOR) - Morbidity Study; OPP1032340-A).

Specific Aims

Specific Aim 1: To assess whether macrolide resistance is greater in a population-based community sample of pre-school children, or in a clinic-based sample of ill pre-school children

Specific Aim 2: To assess whether biannual mass azithromycin treatments of pre-school children can eliminate ocular chlamydia in a hypoendemic area

Specific Aim 3: To assess the diversity of the microbiome of the nasopharynx, oropharynx, nares, conjunctiva, and gastrointestinal tract


Childhood Mortality Azithromycin Mass treatment Infection Bacterial infections Trachoma Chlamydia infections Malaria Diarrhea Respiratory Infections Antibiotic resistance Verbal Autopsy Microbiome


You can join if…

Open to people ages 1 month and up


  • The community location in target district.
  • The community leader consents to participation in the trial
  • The community's estimated population is between 200-2,000 people.
  • The community is not in an urban area.

Individuals (Intervention):

  • Children-treated arms (all 3 sites): All children aged 1-60 months (up to but not including the 5th birthday), as assessed at the most recent biannual census
  • Everyone-treated arm (Niger only): All individuals aged 1 month and up, as assessed at the most recent biannual census

Individuals (Examination & Sample Collection):

  • All swabs, blood tests, and stool samples: A random sample of children aged 1-60 months (up to but not including the 5th birthday) based on the previous census
  • Anthropometric measurements: All children aged 1-60 months (up to but not including the 5th birthday) will have anthropometric measurements assessed.
  • Nasopharyngeal swabs in untreated children: A random sample of individuals aged 7 - 12 years (7th birthday up to but not including the 12th birthday), as assessed from the previous census
  • Clinic-based nasopharyngeal swabs: All children aged 1-60 months (up to but not including the 5th birthday) who present to a local health clinic in the study area and report symptoms of a respiratory infection

You CAN'T join if...


  • Pregnant women
  • All those who are allergic to macrolides or azalides
  • Refusal of village chief (for village inclusion), or refusal of parent or guardian(for individual inclusion)


  • Johns Hopkins University in progress, not accepting new patients
    Baltimore, Maryland, 21205, USA
  • College of Medicine at the University of Malawi, Blantyre accepting new patients
    Blantyre, Malawi
  • The Carter Center, Niger accepting new patients
    Niamey, Niger
  • Kongwa Trachoma Project accepting new patients
    Kongwa, Tanzania
  • London School of Hygiene & Tropical Medicine in progress, not accepting new patients
    London, United Kingdom


accepting new patients
Start Date
Completion Date
University of California, San Francisco
Phase 4
Lead Scientist
Tom M Lietman
Study Type
Last Updated
October 2016