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BackgroundAntimicrobial resistance (AMR) in Neisseria gonorrhoeae (N. gonorrhoeae) is an urgent global health concern. Commensal Neisseria species in the oropharynx are an important reservoir of AMR genes that are transferred to N. gonorrhoeae, yet few data about AMR among commensal Neisseria in populations at risk for AMR exist.MethodsFrom May 2022 to December 2023, men in an HIV pre-exposure prophylaxis program in Hanoi, Vietnam, were recruited for this study. Participants self-collected oral specimens using phosphate buffer solution, for culture on LB agar media containing sucrose, vancomycin, and trimethoprim (LBVT.SNR). Oxidase-positive Gram-negative diplococci were identified using the Remel RapID NH system. Minimum inhibitory concentrations (MICs) to azithromycin, ceftriaxone, cefixime, and doxycycline were determined using Etests.ResultsThere were 42 male participants, the median age was 26 years and 29% (n = 12) reported using antibiotics in the past 6 months. In total, 48 Neisseria isolates were recovered; N. sicca/subflava was the most common species (50%; n = 24), followed by N. mucosa (38%; n = 18). For azithromycin, 85% (n = 41) of isolates were resistant with MICs ≥ 1 ug/mL, including 25% (n = 12) with high-level resistance (MICs ≥ 256 ug/mL of which 67% (8/12) were N. mucosa. Among non-gonococcal Neisseria isolates, the prevalence of resistance was 6% (n = 3) for ceftriaxone, 6% (n = 3) for cefixime, and 54% (n = 26) for doxycycline; the most non-susceptible isolates were N. mucosa.ConclusionsA High frequency of azithromycin resistance, moderate doxycycline resistance, and low cephalosporin resistance was found in oropharyngeal Neisseria isolates from men who have sex with men (MSM) in a pre-exposure prophylaxis (PrEP) program in Hanoi, Vietnam. N. mucosa was over-represented among resistant isolates.

Although community randomized trials have found a reduction in all-cause child mortality in communities receiving mass azithromycin distribution compared with placebo, individually randomized trials have not found similar protective effects. If a direct effect of azithromycin for prevention of child mortality exists, it is likely due to reduction in infectious mortality. Here, we assessed cause-specific mortality in a large randomized controlled trial of azithromycin administered during well-infant visits in Burkina Faso for prevention of mortality. Among 32,877 enrolled infants, the most common causes of death by 6 months of age were malaria, acute respiratory infections, and diarrheal disease. We found no evidence of a difference in the distribution of cause of death by randomized treatment assignment (P = 0.42) or in any infectious-specific cause of death. The results of this analysis are consistent with no direct effect of azithromycin on infant mortality when administered during well-infant visits.

BackgroundTrachoma programs use the indicator trachomatous inflammation--follicular (TF) to monitor indication for and response to treatment for trachoma at the district level. Alternative indicators, including serologic markers, are increasingly being evaluated for trachoma surveillance. We evaluated seroprevalence of IgG antibodies to the Pgp3 antigen in two districts in Maradi, Niger thought to have low TF prevalence.MethodsData were collected as part of the baseline assessment of the Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) trial in September 2021. A random sample of 80 communities was selected from Mayahi and Guidan Roumdji districts, both of which had TF prevalence

BACKGROUND: The risk of antibiotic resistance is complicated by the potential for spillover effects from one treated population to another. Azithromycin mass drug administration programs report higher rates of antibiotic resistance among treatment arms in targeted groups. This study aimed to understand the risk of spillover of antibiotic resistance to nontarget groups in these programs. METHODS: Data were used from a cluster-randomized trial comparing the effects of biannual azithromycin and placebo distribution to children 1-59 months old on child mortality rates. Nasopharyngeal samples from untreated children 7-12 years old were tested for genetic determinants of macrolide resistance (primary outcome) and resistance to other antibiotic classes (secondary outcomes). Linear regression was used to compare the community-level mean difference in prevalence by arm at the 24-month time point, adjusting for baseline prevalence. RESULTS: A total of 1103 children 7-12 years old in 30 communities were included in the analysis (15 azithromycin, 15 placebo). The adjusted mean differences in the prevalence of resistance determinants for macrolides, β-lactams, and tetracyclines were 3.4% (95% confidence interval, -4.1% to 10.8%; P = .37), -1.2% (-7.9% to 5.5%; P = .72), and -3.3% (-9.5% to 2.8%; P = .61), respectively. CONCLUSIONS: We were unable to demonstrate a statistically significant increase in macrolide resistance determinants in untreated groups in an azithromycin mass drug administration program. While the result might be consistent with a small spillover effect, this study was not powered to detect such a small difference. Larger studies are warranted to better quantify the potential for spillover effects within these programs.