{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T01:53:30Z","timestamp":1775354010596,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,7,24]],"date-time":"2018-07-24T00:00:00Z","timestamp":1532390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["1032340"],"award-info":[{"award-number":["1032340"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["K08EY026986"],"award-info":[{"award-number":["K08EY026986"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mass distributions of oral azithromycin have long been used to eliminate trachoma, and they are now being proposed to reduce childhood mortality. The observed benefit appears to be augmented with each additional treatment, suggesting a possible community-level effect. Here, we assess whether 2 biannual mass treatments of preschool children affect the community\u2019s gut microbiome at 6 months after the last distribution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cluster-randomized controlled trial, children aged 1\u201360 months in the Dossa region of Niger were randomized at the village level to receive a single dose of azithromycin or placebo every 6 months. Fecal samples were collected 6 months after the second treatment for metagenomic deep sequencing. The prespecified primary outcome was the Euclidean PERMANOVA of the gut microbiome, or effectively the distance between the genus-level centroid at the community level, with the secondary outcome being the Simpson\u2019s \u03b1 diversity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the azithromycin arm, the gut microbial structures were significantly different than in the placebo arm (Euclidean PERMANOVA, P &amp;lt; .001). Further, the diversity of the gut microbiome in the azithromycin arm was significantly lower than in the placebo arm (inverse Simpson\u2019s index, P = .005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Two mass azithromycin administrations, 6 months apart, in preschool children led to long-term alterations of the gut microbiome structure and community diversity. Here, long-term microbial alterations in the community did not imply disease but were associated with an improvement in childhood mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trials Registration<\/jats:title><jats:p>NCT02048007.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofy182","type":"journal-article","created":{"date-parts":[[2018,7,24]],"date-time":"2018-07-24T05:19:17Z","timestamp":1532409557000},"source":"Crossref","is-referenced-by-count":32,"title":["Mass Azithromycin Distribution and Community Microbiome: A Cluster-Randomized Trial"],"prefix":"10.1093","volume":"5","author":[{"given":"Thuy","family":"Doan","sequence":"first","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armin","family":"Hinterwirth","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M","family":"Arzika","sequence":"additional","affiliation":[{"name":"The Carter Center Niger, Republique du Niger, Niger"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sun Y","family":"Cotter","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn J","family":"Ray","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kieran S","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lina","family":"Zhong","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric D","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoxia","family":"Zhou","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milo E","family":"Cummings","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionna","family":"Fry","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine E","family":"Oldenburg","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee","family":"Worden","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis C","family":"Porco","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy D","family":"Keenan","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, San Francisco, California"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M","family":"Lietman","sequence":"additional","affiliation":[{"name":"Francis I. 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