{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:13:48Z","timestamp":1783707228522,"version":"3.55.0"},"reference-count":111,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W006677\/1"],"award-info":[{"award-number":["MR\/W006677\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Azithromycin mass drug administration (MDA) can reduce under-5 mortality in stable but high-mortality settings, yet its potential in humanitarian crises remains undefined. This review proposes that azithromycin MDA could support existing humanitarian interventions and help address mortality from respiratory and gastrointestinal infections in displaced populations. Mortality rates in crises frequently exceed WHO recommended thresholds for initiating MDA. Operationally, the MDA is feasible, low-cost, and synergises with existing relief efforts like vaccination. While antimicrobial resistance (AMR) is a serious concern, the proposed use, likely a single round or short-term intervention during acute emergencies, may mitigate long-term resistance selection compared to routine biannual dosing. The potential to rapidly reduce excess mortality may outweigh the AMR risks. Azithromycin MDA represents a promising new tool for humanitarian health, though evidence-based protocols and resistance monitoring strategies must be developed through further research.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006684","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:22:27Z","timestamp":1783704147000},"page":"e0006684","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Azithromycin mass drug administration to reduce childhood mortality in humanitarian crises"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-0737","authenticated-orcid":true,"given":"Gregory","family":"Barnsley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3345-5971","authenticated-orcid":true,"given":"Matthew","family":"Coldiron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Russell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aula","family":"Abbara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2335-5367","authenticated-orcid":true,"given":"Douglas James","family":"Noble","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Flasche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"van Zandvoort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhargavi","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"pgph.0006684.ref001","volume-title":"UNHCR Global Trends 2023","author":"UNHCR","year":"2024"},{"key":"pgph.0006684.ref002","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13031-016-0082-9","article-title":"Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998-2012) - insights from operational data","volume":"10","author":"P Heudtlass","year":"2016","journal-title":"Confl Health"},{"issue":"9711","key":"pgph.0006684.ref003","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/S0140-6736(09)61967-X","article-title":"Patterns of mortality rates in Darfur conflict","volume":"375","author":"O Degomme","year":"2010","journal-title":"Lancet"},{"key":"pgph.0006684.ref004","article-title":"Public health in crisis-affected populations: a practical guide for decision-makers","volume":"61","author":"F Checchi","year":"2007","journal-title":"Humanit Pract Netw"},{"issue":"5","key":"pgph.0006684.ref005","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1017\/dmp.2021.213","article-title":"Comparing primary health-care service delivery disruptions across disasters","volume":"16","author":"TA Radcliff","year":"2022","journal-title":"Disaster Med Public Health Prep"},{"key":"pgph.0006684.ref006","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/padr.12450","article-title":"Public health and armed conflict: immunization in times of systemic disruptions","volume":"47","author":"G \u00d8stby","year":"2021","journal-title":"Popul Dev Rev"},{"key":"pgph.0006684.ref007","article-title":"Severe acute malnutrition and infection","author":"KDJ Jones","year":"2014","journal-title":"Paediatr Int Child Health"},{"issue":"5","key":"pgph.0006684.ref008","doi-asserted-by":"crossref","first-page":"770","DOI":"10.3945\/an.117.016121","article-title":"Evaluation of nutrition interventions in children in conflict zones: a narrative review","volume":"8","author":"GJ Carroll","year":"2017","journal-title":"Adv Nutr"},{"issue":"11","key":"pgph.0006684.ref009","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1080\/21645515.2015.1096457","article-title":"Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations","volume":"11","author":"E Lam","year":"2015","journal-title":"Hum Vaccin Immunother"},{"key":"pgph.0006684.ref010","article-title":"Azithromycin","volume-title":"StatPearls","author":"Z Sandman","year":"2023"},{"key":"pgph.0006684.ref011","first-page":"353","article-title":"WHO alliance for the global elimination of trachoma: progress report on elimination of trachoma","volume":"97","author":"World Health Organization","year":"2022","journal-title":"Wkly Epidemiol Rec Relev\u00e9 \u00c9pid\u00e9miologique Hebd"},{"key":"pgph.0006684.ref012","unstructured":"WHO guideline on mass drug administration of azithromycin to children under five years of age to promote child survival. 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