Effect of Mass Azithromycin Distribution on Antibiotic Resistance in the Gut and Nasopharynx: A Cluster-Randomized Trial

Repeated twice-yearly azithromycin mass drug distribution (MDA) to preschool children reduced all-cause childhood mortality. However, the potential selection of antibiotic resistance (AMR) is a major public health concern as the program is being implemented in multiple countries in sub-Saharan Africa. This study evaluated the impact of azithromycin MDA targeting different age groups on the gut and nasopharyngeal microbiome and resistome of children in participating communities.