Implementation of mass drug administration of antibiotics in low- and middle- income countries

Abstract

Abstract Background Recent years has seen the mass administration of certain antimicrobials, including antibiotics, increasingly promoted as a public health strategy in low- and middle-income countries (LMICs). The WHO currently recommends the mass administrations of azithromycin for three indications: yaws, trachoma, and child mortality. Methods We conducted a desk-based review of secondary data to discuss the clinical, public health and economic evidence underpinning the decision to adopt, and the issues to consider when implementing a mass drug administration (MDA) programme involving azithromycin. Results Before deciding to adopt and implement a policy of MDA of antibiotics, the evidence base should be evaluated, including an economic assessment, and consideration of the distribution of benefits and risks amongst individuals and within communities and populations. Once the decision to adopt has been made, key considerations for successful implementation of a programme include ensuring it does not draw attention and resources away from other health services and finding opportunities for generating efficiencies through integration with existing health interventions. Understanding local attitudes and gaining trust are essential for stakeholder buy-in Furthermore, there must be appropriate attention to the potential harms which include worsening antimicrobial resistance, unintended consequences of public health interventions and reinforcement of a selective primary healthcare paradigm at the expense of a more bottom-up, comprehensive and socially driven pathway to health improvement. Conclusion Although MDA of antibiotics presents an opportunity to prevent mortality and improve health in the short-term, in the case of childhood mortality, MDA of azithromycin can only be a short-term quick fix. Ultimately, long-term, and sustainable child mortality reductions – especially in high mortality settings – will require more comprehensive approaches to health system strengthening and broader-based socio-economic development.