zithromax and Giardiasis

The MORDOR trial in Niger, Malawi, and Tanzania found that biannual mass distribution of azithromycin to children younger than 5 years led to a 13.5% reduction in all-cause mortality (NCT02048007). To help elucidate the mechanism for mortality reduction, we report IgG responses to 11 malaria, bacterial, and protozoan pathogens using a multiplex bead assay in pre-specified substudy of 30 communities in the rural Niger placebo-controlled trial over a three-year period (n = 5642 blood specimens, n = 3814 children ages 1-59 months). Mass azithromycin reduces Campylobacter spp. force of infection by 29% (hazard ratio = 0.71, 95% CI: 0.56, 0.89; P = 0.004) but serological measures show no significant differences between groups for other pathogens against a backdrop of high transmission. Results align with a recent microbiome study in the communities. Given significant sequelae of Campylobacter infection among preschool aged children, our results support an important mechanism through which biannual mass distribution of azithromycin likely reduces mortality in Niger.

Topics: Anti-Bacterial Agents; Azithromycin; Campylobacter Infections; Child; Child Mortality; Child, Preschool; Cryptosporidiosis; Drug Resistance, Bacterial; Escherichia coli Infections; Follow-Up Studies; Giardiasis; Humans; Immunoglobulin G; Infant; Malaria; Mass Drug Administration; Niger; Rural Population; Salmonella Infections

Cryptosporidium species and Giardia intestinalis are the most common enteric protozoan pathogens affecting humans worldwide. In recent years, nitazoxanide has been licensed in the United States for the treatment of cryptosporidiosis in non-immunodeficient children and adults, becoming the first drug approved for treating this disease. There is a need for a highly effective treatment for cryptosporidiosis in immunodeficient patients, but the quest for such a drug has proven to be elusive. While not effective against Cryptosporidium, nitroimidazoles such as metronidazole or tinidazole are effective treatments for giardiasis and can be administered as a single dose. Albendazole and nitazoxanide are effective against giardiasis but require multiple doses. Nitazoxanide is the first new drug developed for treating giardiasis in more than 20years. New potentially promising drug targets in Cryptosporidium and Giardia have been identified, but there appears to be little activity toward clinical development of new drugs.

Topics: AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Antiparasitic Agents; Antiretroviral Therapy, Highly Active; Azithromycin; Benzimidazoles; Cryptosporidiosis; Giardia lamblia; Giardiasis; Humans; Nitro Compounds; Nitroimidazoles; Paromomycin; Roxithromycin; Thiazoles

Giardia intestinalis infection is a common cause of diarrhoea in humans and other mammalian species throughout the world. This report describes a case of a dog suffering from diarrhoea, infected with G. intestinalis, effectively treated with azithromycin. Azithromycin is an azalide, semisynthetic macrolide antibiotic having a large spectrum of activity against bacterial pathogens and some protozoa. In this case, Giardia infection in a dog was confirmed by microscopic examination and PCR. Sequencing of the detected Giardia amplicon confirmed infection with assemblage A-I. The dog received azithromycin administered at dose of 10 mg/kg per os, once a day for 5 days. After the therapy, the diarrhoea stopped. Effectiveness of the treatment was also confirmed by PCR and microscopic examination. This is the first report on the therapy of canine giardiosis with azithromycin. It seems that azithromycin can be considered as promising antibiotic for the control of Giardia infection in dogs.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Dog Diseases; Dogs; Giardia lamblia; Giardiasis; Male; Treatment Outcome