{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:11:30Z","timestamp":1778803890677,"version":"3.51.4"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HD079695"],"award-info":[{"award-number":["R01HD079695"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"NIH National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["1R01AI150978"],"award-info":[{"award-number":["1R01AI150978"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"NIH National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["5T32ES015459"],"award-info":[{"award-number":["5T32ES015459"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1131320"],"award-info":[{"award-number":["OPP1131320"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag028","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T12:26:32Z","timestamp":1768307192000},"page":"957-965","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of a 5-Day Course of Azithromycin on\n                    <i>Streptococcus Pneumoniae<\/i>\n                    Carriage and Antimicrobial Resistance Among Kenyan Children Discharged From Hospital"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-9206","authenticated-orcid":false,"given":"Tanya E","family":"Libby","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Karani","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme , Kilifi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4108-1236","authenticated-orcid":false,"given":"Kirkby D","family":"Tickell","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2637-3708","authenticated-orcid":false,"given":"Donald","family":"Akech","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme , Kilifi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benson","family":"Singa","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute , Nairobi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-1887","authenticated-orcid":false,"given":"Doreen","family":"Rwigi","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute , Nairobi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6586-1504","authenticated-orcid":false,"given":"Kevin","family":"Kariuki","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute , Nairobi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy","family":"Onamu","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute , Nairobi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derrick","family":"Ounga","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute , Nairobi ,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James A","family":"Berkley","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme , Kilifi ,","place":["Kenya"]},{"name":"Centre for Tropical Medicine & Global Health, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4836-720X","authenticated-orcid":false,"given":"Judd L","family":"Walson","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7533-5006","authenticated-orcid":false,"given":"J Anthony G","family":"Scott","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme , Kilifi ,","place":["Kenya"]},{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia B","family":"Pavlinac","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington 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