- Doan, Thuy;
- Liu, Zijun;
- Sié, Ali;
- Dah, Clarisse;
- Bountogo, Mamadou;
- Ouattara, Mamadou;
- Coulibaly, Boubacar;
- Kiemde, Dramane;
- Zonou, Guillaume;
- Nebie, Eric;
- Brogdon, Jessica;
- Lebas, Elodie;
- Hinterwirth, Armin;
- Zhong, Lina;
- Chen, Cindi;
- Zhou, Zhaoxia;
- Porco, Travis;
- Oldenburg, Catherine;
- Lietman, Thomas;
- Arnold, Benjamin
Mass antibiotic distribution to preschool children resulted in alterations of the gut microbiome months after distribution. This individually randomized, placebo-controlled trial evaluated changes in the gut microbiome and resistome in children aged 8 days to 59 months after one dose of oral azithromycin in Burkina Faso. A total of 450 children were randomized in a 1:1 ratio to either placebo or azithromycin. Rectal samples were collected at baseline, 2 weeks, and 6 months after randomization and subjected to DNA deep sequencing. Gut microbiome diversity and normalized antimicrobial resistance determinants for different antibiotic classes were evaluated. Azithromycin decreased gut bacterial diversity (Shannon P < 0.0001; inverse Simpson P < 0.001) 2 weeks after treatment relative to placebo. Concurrently, the normalized abundance of macrolide resistance genetic determinants was 243-fold higher (95% CI: 76-fold to 776-fold, P < 0.0001). These alterations did not persist at 6 months, suggesting that disruptions were transient. Furthermore, we were unable to detect resistance changes in other antibiotic classes, indicating that co-resistance with a single course of azithromycin when treated at the individual level was unlikely.