Improving Antibiotic Access to Save Children’s Lives in Sub-Saharan Africa

Improving Antibiotic Access to Save Children’s Lives in Sub-Saharan Africa

In some parts of sub-Saharan Africa, nearly 10 percent of children die before they turn 5 years old; in 2022 alone, around 2.8 million young children died in the entire region. Most are dying from pneumonia, diarrhea, or malaria — diseases that can be treated with antibiotics.

The Challenge of Antibiotic Resistance
Prescribing antibiotics to all children under 5 increases the risk of disease-causing bacteria developing resistance to the medication. This is a significant concern, as antibiotic resistance can render these life-saving drugs ineffective in treating infections. To address this issue, current recommendations limit routine, widespread antibiotics to infants between 1 and 11 months old. However, a new study has found that treating everyone younger than 5 not only benefits older kids but also further reduces mortality in infants.

Study Findings on Antibiotic Treatment
Epidemiologist Thomas Lietman, along with his team, conducted a study that revealed treating older children under 5 with antibiotics had a spillover effect on reducing mortality in infants. Lietman stated, “We were very surprised that we were able to prove that spillover effect, that treating the older kids actually helped the younger kids. It appears to be the majority of the antibiotic benefit is indirect, more than direct.”

In a large trial conducted in Niger, Malawi, and Tanzania in 2018, researchers found that a single dose of azithromycin twice a year for children under 5 could reduce mortality by almost 14 percent. This significant finding led the World Health Organization (WHO) to recommend the treatment, but they stopped short of suggesting it be given to all children under age 5. According to Lietman, the WHO’s decision to restrict the recommendation to infants was likely due to the higher mortality rate in that age group.

The AVENIR Trial: Treating All Children Under 5
To further investigate the impact of antibiotic treatment on children under 5, a follow-up trial called AVENIR was conducted from 2020 to 2023 in Niger. The study included more than 380,000 children under age 5 who were assigned to one of three groups: infants 1 to 11 months receiving treatment, all children under 5 receiving treatment, or all children under 5 receiving a placebo.

The results of the AVENIR trial, published in the New England Journal of Medicine, showed that treating all children under 5 reduced mortality for infants by 17 percent. This significant reduction in deaths highlights the potential benefits of expanding antibiotic treatment to a broader age group.

Implications of the Study Findings
Researchers, including study coauthor Kieran O’Brien, emphasized the importance of updating guidelines to recommend treatment for 1-to-59-month-olds. O’Brien stated, “I think we would hope to see the guidelines updated to recommend treatment to 1-to-59-month-olds, with whatever conditions made sense at the time the guidelines were created.”

The current guidelines already emphasize the importance of monitoring antibiotic resistance and implementing measures to address any resistance that may arise. Moving forward, researchers are focused on determining when to stop treatment, assessing the impact of resistance, and establishing the duration of treatment needed to sustain a reduction in mortality.

Overall, the goal is to reduce transmission of diseases effectively to eliminate the need for mass distribution of antibiotics in the future. By expanding access to antibiotics and implementing comprehensive monitoring strategies, healthcare providers can save more children’s lives in sub-Saharan Africa.

Conclusion
The findings from the AVENIR trial underscore the potential benefits of expanding antibiotic access to all children under 5 in sub-Saharan Africa. By addressing the challenge of antibiotic resistance and focusing on comprehensive monitoring strategies, healthcare providers can effectively reduce mortality rates and save more young lives in the region. This study highlights the importance of evidence-based interventions in improving child health outcomes and underscores the need for continued research and collaboration to address health challenges in vulnerable populations.