Azithromycin at discharge does not reduce pneumococcal carriage in Kenyan children

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The Journal of infectious diseases Published May 15, 2026 Medically reviewed May 22, 2026 Study authors: Libby Tanya E, Karani Angela, Tickell Kirkby D, Akech Donald, Singa Benson, Rwigi Doreen, Kariuki Ke… PubMed ↗ NCT02414399 ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Post-discharge azithromycin did not reduce pneumococcal carriage or resistance in Kenyan children over six months.

A randomized, placebo-controlled trial in Kenya evaluated whether a 5-day course of oral azithromycin given at hospital discharge could reduce pneumococcal carriage and antibiotic resistance in children. The study enrolled 1,398 hospitalized Kenyan children, randomizing them to receive either azithromycin or a placebo at discharge, with follow-up for six months.

The primary outcome was pneumococcal carriage. At discharge, carriage rates were similar between groups (22.5% vs 24.6%). At three and six months, carriage prevalence ratios were 0.98 and 1.00, respectively, with 95% confidence intervals including 1.0, indicating no significant difference.

For azithromycin resistance, no difference was observed between groups at three months (PR 1.06) or six months (PR 1.01), with confidence intervals spanning 1.0. Safety data were not reported, and the study noted high baseline antibiotic use may have limited any additional effect of azithromycin.

These findings suggest that routine azithromycin at discharge may not be effective for reducing pneumococcal carriage or resistance in this setting, highlighting the need for alternative strategies.

Study Details

Study typeRct

EvidenceLevel 2

Follow-up6.0 mo

PublishedMay 2026

PMID41542944

TrialNCT02414399

View Original Abstract ↓

BACKGROUND: Mass azithromycin distribution reduces child mortality in some settings, potentially through reductions in nasopharyngeal carriage of Streptococcus pneumoniae, but has been associated with increased antimicrobial resistance. Individual-level data are lacking on the impact of azithromycin on antimicrobial resistance over time. METHODS: We analyzed data from a double-blind, randomized placebo-controlled trial (ClinicalTrials.gov; NCT02414399) which followed 1398 hospitalized Kenyan children to evaluate the impact of a 5-day course of oral azithromycin at discharge from hospital on pneumococcal carriage and the proportion of isolates (among a random sample) resistant to azithromycin. Randomization to azithromycin or placebo (1:1) was stratified by enrollment county (Kisii or Homa Bay). Using generalized estimating equations, we calculated prevalence ratios (PRs) and 95% CIs for the intervention, adjusting for enrollment site. RESULTS: Overall, 1253/1398 (89.6%) enrolled children received antibiotics during their hospitalization. Pneumococcal carriage at discharge was similar among children randomized to the azithromycin group (158/702 [22.5%]) compared with the placebo group (171/696 [24.6%]; P = .4) and did not differ at month 3 (65.6% versus 67.0%; PR: 0.98 [0.90, 1.06]) or month 6 (66.7% versus 66.5%; PR: 1.00 [0.92, 1.08]). At discharge, 15.7% of isolates were resistant to azithromycin and there was no difference between azithromycin-treated and placebo groups at month 3 (35/266 [13.2%] versus 32/256 [12.5%]; PR: 1.06 [0.86, 1.66]) or month 6 (41/245 [16.7%] versus 43/243 [17.6%]; PR: 1.01 [0.69, 1.49]). CONCLUSIONS: Azithromycin treatment did not effect pneumococcal carriage or antimicrobial resistance 3- or 6-months post-randomization. High inpatient antibiotic use in this recently discharged population may have reduced any further impact of azithromycin.