Annual Versus Biannual Mass Azithromycin Distribution and Malaria Parasitemia During the Peak Transmission Season Among Children in Niger

Azithromycin has modest efficacy against malaria, and previous cluster randomized trials have suggested that mass azithromycin distribution for trachoma control may play a role in malaria control. We evaluated the effect of annual versus biannual mass azithromycin distribution over a three-year period on malaria prevalence during the peak transmission season in a region with seasonal malaria transmission in Niger. Twenty-four communities in Matameye, Niger were randomized to annual mass azithromycin distribution (3 distributions to the entire community during the peak transmission season) or biannual targeted azithromycin distribution (6 distributions to children <12 years, including 3 in the peak transmission season and 3 in the low transmission season). Malaria indices were evaluated at 36 months during the high transmission season. Parasitemia prevalence was 42.6% (95% confidence interval [CI] 31.7 to 53.6%) in the biannual distribution arm compared with 50.6% (95% CI 40.3 to 60.8%) in the annual distribution arm (P=0.29). There was no difference in parasite density or hemoglobin concentration in the two treatment arms. Additional rounds of mass azithromycin distribution during low transmission may not have a significant impact on malaria parasitemia measured during the peak transmission season. clinicaltrials.gov NCT00792922.