BMJ Glob Health. 2025 Nov 23;10(11):e020294. doi: 10.1136/bmjgh-2025-020294.
ABSTRACT
INTRODUCTION: Children discharged following hospitalisation for acute illnesses in low- and middle-income settings are at increased risk of poor growth, particularly linear growth faltering. We aimed to determine the effect of azithromycin administered at hospital discharge on post-discharge growth.
METHODS: Using data from the Toto Bora Trial (NCT02414399), a double-blind, placebo-controlled randomised trial of a 5-day course of azithromycin in Kenyan children aged 1-59 months, we assessed differences in mean monthly change in growth (height-for-age z-score (HAZ), weight-for-height z-score (WHZ), weight-for-age z-score (WAZ)) in the 6 months following hospital discharge.
RESULTS: This analysis included 1276 children who survived to 6 months post-discharge (640 randomised to azithromycin and 636 to placebo). At discharge, 285 (22%) of children were stunted, 64 (5%) were wasted and 156 (12%) were underweight. There was no difference in 6-month post-discharge growth (mean difference: HAZ, 0.010 (95% CI -0.005 to 0.025); WAZ, 0.003 (95% CI -0.013 to 0.019); WHZ, -0.003 (95% CI -0.025, 0.019)) between treatment groups. Further, no differences in mean monthly change in HAZ, WAZ or WHZ were observed between randomisation groups when stratified by age, nutritional status at discharge or discharge diagnosis. Mean monthly change in HAZ declined among all children in the 6 months post-discharge, irrespective of the treatment group (azithromycin group: -0.038 (95% CI -0.049 to -0.028); placebo group: -0.048 (95% CI -0.059 to -0.038). Mean monthly change in WAZ did not differ significantly by treatment group (0.025 (95% CI 0.013 to 0.037) in the azithromycin group and 0.022 (95% CI 0.011 to 0.033) in placebo (p=0.688)). Monthly WAZ and WHZ gains were similar in both groups, with greater weight gains among older children (6-11, 12-23, 24-59 months).
CONCLUSION: We did not observe statistically significant improvements in post-discharge growth among children receiving azithromycin at hospital discharge.
TRIAL REGISTRATION NUMBER: NCT02414399.
PMID:41285436 | DOI:10.1136/bmjgh-2025-020294
