P3.084: Efficacy of Biannual Azithromycin to reduce mortality in children: A Systematic Review and Meta-Analysis

Background: Despite global reductions in child mortality, high mortality rates persist in parts of West Africa. Biannual azithromycin administration has shown promise in reducing mortality in children under five in regions with high mortality rates, particularly in Sub-Saharan Africa. We sought to evaluate the efficacy of biannual azithromycin in reducing all-cause mortality in children aged 1–59 months through a systematic review and meta-analysis

Methods: A meta-analysis was conducted following PRISMA guidelines. We included five studies (2020-2025) comprising 1,157,393 children (593,150 in the azithromycin group and 564,243 in the placebo group). Studies were sourced from PubMed, Scopus, Cochrane Library, and clinical trial registries. The primary outcome was all-cause mortality, analyzed using the random-effects model. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated. Subgroup and sensitivity analyses were performed to assess heterogeneity.

Results: Azithromycin administration significantly reduced all-cause mortality by 13% (RR = 0.87; 95% CI: 0.81–0.93, p < 0.00001). Mortality per 1000 person-years also decreased by 11% (RR = 0.89; 95% CI: 0.85–0.93, p < 0.00001). Subgroup analyses by region showed consistent findings. Sensitivity analysis reduced heterogeneity after excluding specific trials.

Conclusion: Biannual azithromycin administration is associated with a significant reduction in child mortality. This intervention may be an effective public health strategy for reducing childhood mortality in high-risk regions. Further studies are needed to explore the long-term sustainability and potential for antibiotic resistance.