The antibiotic can no longer be used in moderate acne vulgaris, eradication of Helicobacter pylori, and prevention of exacerbations of asthma.

Drs. Lisa Noguchi and Bina Valsangkar highlight azithromycin’s historical successes and trace the drug’s path through time, helping clarify the evidence for reducing maternal, neonatal, and child mort...

In Kenyan children who received azithromycin after hospital discharge, the presence of a macrolide-resistance gene was tied to higher risk of re-hospitalization or death.

The Toto Bora trial tested whether a 5-day course of azithromycin reduced the risk of re-hospitalization or death in the 6 months following hospitalization among Kenyan children and found no overall benefit. We hypothesized that macrolide resistance in gut microbes could modify azithromycin’s effect.MethodsFrom June 2016 to November 2019, Kenyan children aged 1-59 months were enrolled at hospital discharge and randomized to azithromycin or placebo. DNA from fecal samples and E. coli isolates was analyzed for common macrolide resistance genes. Cox proportional hazards regression models, including interaction terms between randomization arm and individual macrolide-resistance genes, were used to analyze time to rehospitalization or death, with Bonferroni correction applied to account for multiple comparisons.ResultsAmong 1,393 children tested, 94.7% had at least one macrolide-resistance gene in their fecal DNA at hospital discharge; most commonly mph(A) (68.6%; 955/1393), followed by msr(D) (67.3%; (937/1393), and erm(B) (60.7%; 846/1393). Mef(A) (23.7%; 330/1393) was the only macrolide-resistance gene that modified azithromycin’s effect on re-hospitalization or death (interaction p-value=0.008). In children without the mef(A) gene, azithromycin reduced the hazard of rehospitalization or death by a third (HR=0.66, 95%CI: 0.45-0.99) whereas among children with the mef(A) gene, there was a higher risk in those randomized to azithromycin (HR=2.72, 95%CI: 1.21-6.09). The effect size of azithromycin's impact on mortality and rehospitalization as separate outcomes in children with and without mef(A) were consistent but underpowered.InterpretationMacrolide resistance in the gut microbiome may influence the efficacy of azithromycin in children discharged from the hospital.

We hypothesized that macrolide resistance in gut microbes could modify azithromycin’s effect. Methods From June 2016 to November 2019, Kenyan children aged 1-59 months were enrolled at hospital discharge and randomized to azithromycin or placebo.

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The human gut is a complex ecosystem teeming not just with bacteria but also a diverse community of fungi, collectively known as the mycobiota. While the gut bacteriome has long been the focus of

The human gut is a complex ecosystem teeming not just with bacteria but also a diverse community of fungi, collectively known as the mycobiota. While the gut bacteriome has long been the focus of intensive research for its role in health and disease, emerging evidence suggests the mycobiome plays equally critical and nuanced roles in early life development and immune modulation.