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<jats:title>Abstract</jats:title> <jats:p>The reduction in childhood mortality noted in trials investigating azithromycin mass drug administration (MDA) for trachoma control has been confirmed by a recent large randomized controlled trial. Population-level implementation of azithromycin MDA may lead to selection of multiresistant pathogens. Evidence suggests that repeated azithromycin MDA may result in a sustained increase in macrolide and other antibiotic resistance in gut and respiratory bacteria. Current evidence comes from standard microbiological techniques in studies focused on a time-limited intervention, while MDA implemented for mortality benefits would likely repeatedly expose the population over a prolonged period and may require a different surveillance approach. Targeted short-term and long-term surveillance of resistance emergence to key antibiotics, especially those from the World Health Organization Access group, is needed throughout any implementation of azithromycin MDA, focusing on a genotypic approach to overcome the limitations of resistance surveillance in indicator bacteria.</jats:p> <jats:p>Azithromycin mass drug administration results in a sustained increase in antimicrobial resistance when implemented at a population level. Targeted risk-based metagenomics approaches complementing traditional microbiological methods are recommended for surveillance of emerging short- and long-term antimicrobial resistance.</jats:p>

Original publication





Clinical Infectious Diseases


Oxford University Press (OUP)

Publication Date