A 16%–22% decrease in microbiota α-diversity was reported after 12 months. MDA comprised of one dose of azithromycin given biannually to every child 1–60 months of age in participating communities in Niger. The impact of long-term use was reported in three studies representing data from a single cluster-RCT. All five RCTs were conducted in low- and middle-income countries (LMICs). One RCT investigated impacts on the microbiota after repeated biannual treatment over a follow-up period of 48-months (long-term use), and four RCTs investigated impacts in the period immediately following a single dose or course of treatment (short-term use). The gut microbiome was characterized primarily in terms of α-diversity, which quantifies the number of different bacterial taxa in an individual microbiota and the uniformity of their abundances (Table 1). Five randomized controlled trials (RCT) investigated the impact on the gut microbiota of MDA with azithromycin for prophylaxis in the general population.
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Table 1 Characteristics of studies included in this review of the impact of mass drug administration with antibiotics for trachoma, yaws elimination or child mortality reduction on the human gut microbiome Full size tableĪzithromycin is an integral part of the World Health Organization (WHO) strategy to eliminate trachoma and yaws.
To gain further insight into the findings of these MDA studies, other studies that investigated the factors which determine the impact of antibiotic use on the gut microbiome and its recovery, strategies to ameliorate these effects, and potential health outcomes are also discussed. Included studies are summarized in Tables 1, 2, 3. Only articles published in English were included. Publications were included if they (i) reported the impact of antibiotic use on gut microbiome composition or function in the context of MDA and (ii) used high-throughput methods to survey the gut microbiome because those methods provide a more comprehensive catalogue of microbiome composition and antibiotic-associated alterations. References from the initially identified studies were also searched and included in this review if relevant. This search provided an initial set of studies relevant to the topic.
Data for this review were initially identified through a search of PubMed up to March 2021 using the search terms “mass drug administration”, “antibiotic*”, and “microbiome” or “microbiota”.
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