4. EFFICACY OF BIANNUAL AZITHROMYCIN FOR REDUCING PEDIATRIC MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH GEOGRAPHIC SUBGROUP ANALYSIS

EFFICACY OF BIANNUAL AZITHROMYCIN FOR REDUCING PEDIATRIC
MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH
GEOGRAPHIC SUBGROUP ANALYSIS

M.H. Ahmad¹, S. Murtaza², W. Shafiq², F. Murtaza², I. Babar³,
M. Umais³, A. Qadeer³, T. Khalid², H. Zahid², S. Yousuf⁴
¹S. Tentishev Asian International University, Kant, Kyrgyzstan
²Punjab Medical College, Faisalabad, Pakistan
³King Edward Medical University, Lahore, Pakistan
⁴University of Arkansas for Medical Sciences, USA

ABSTRACT
Background: Despite global reductions in child mortality, high mortality rates persist in
parts of West Africa. Biannual azithromycin administration has shown promise in reducing
mortality in children under five in regions with high mortality rates, particularly in Sub
Saharan Africa.
Objective: To evaluate the efficacy of biannual azithromycin in reducing all-cause
mortality in children aged 1–59 months through a systematic review and meta-analysis.
Methodology: A meta-analysis was conducted in accordance with PRISMA guidelines.
We included five studies (2020–2025) comprising 1,143,862 children. The primary outcome
was all-
cause mortality. Risk ratios (RR) with 95% confidence intervals (CIs) were calculated
using a random-effects model.
Results: Azithromycin administration reduced all-cause mortality by 13% (RR = 0.87;
95% CI: 0.81–0.93, p < 0.00001). Mortality per 1000 person-years also decreased by 11%.
Conclusions: Biannual administration of azithromycin is associated with a significant
reduction in child mortality in high-risk settings. However, the magnitude of benefit should be
interpreted with caution due to heterogeneity and potential bias. Further studies are needed to
evaluate long-term outcomes and antibiotic resistance.
Keywords: azithromycin, child mortality, meta-analysis, antibiotic intervention, public
health.