The dilemma between infant mortality and drug resistance

Mohammed H. Zaman, a Howard Hughes Medical Institute investigator and professor of biomedical engineering and international health at Boston University, said in his book "A Short History of Drug-Resistant Bacteria" in May 2021,

In December 2016, Rumina Hassan, a clinical microbiologist and pathologist at the Aga Khan University Hospital in Pakistan, discovered Salmonella typhi that was resistant to ceftriaxone.

Rumina Hassan and Dr. Farah Kamal found that the resistant samples all came from Hyderabad, 100 miles (about 160 kilometers) northeast of Karachi.

Hassan’s team began sending weekly reports to the Sindh provincial government, Karachi local government, and Pakistan National Institute of Health, but received no concrete response.

Hassan's colleague Dr Zahra Hassan sent 100 samples to Professor Gordon Dougan, an expert in genetic markers of infectious disease resistance at the Sanger Institute in Cambridge. Testing by Professor Dougan and Elizabeth Krem confirmed that 89 of the samples were drug-resistant, while the remaining 11 were sensitive to first-line drug treatment.

Professor Dougan and Elizabeth Krem found that the typhoid strains in the samples were resistant to all antibiotics, including chloramphenicol, amoxicillin, ampicillin, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone.

In December 2018, nearly 5,000 people in Pakistan were infected with the typhoid-causing strain. The U.S. Centers for Disease Control and Prevention recommends the use of azithromycin.

From 2014 to 2017, Thomas Littman, a professor at the University of California, San Francisco, led an international team of researchers and clinicians from the United States and Europe to conduct clinical trials in Nigeria, Tanzania, and Malawi.

They gave azithromycin to thousands of children as a preventive measure. All of them were under the age of 5, and all of them were given the drug, whether sick or healthy.

During the study, the children received preventive doses of the drug every six months for two years. All children were divided into two equal groups, with a total of 97,000 children receiving the drug and a control group of 93,000 children receiving a placebo instead of the drug.

The results were quite striking. Children in Nigeria who took azithromycin had an 18% lower mortality rate than those in the control group. The drug had the greatest effect in the youngest children—those under 6 months old. In them, the drug's improvement reduced mortality by nearly 25%.

Thomas Littman concluded that prophylactic use of azithromycin could save the fragile lives of children in poor countries. However, large-scale prophylactic use of azithromycin will lead to the emergence of drug resistance.

Littman realized a problem: Couldn’t we give parents of infants the opportunity to choose?

We can decide: either do not intervene now and put children at risk of high mortality, or reduce mortality now but risk the development of drug resistance 20 years later.

Mohammad H. Zaman said that he didn't know how to choose and didn't know how to answer this question.

Ending:

Abstract: #Mohammad H. Zaman said that he didn’t know how to choose and didn’t know how to answer this question.

Author: Zhu Chuan