A decade ago, the astonishing and unexpected results of a trachoma trial in Ethiopia hinted at the exciting potential of mass azithromycin distribution to significantly reduce all-cause mortality in children by approximately 50%. In 2018, the Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) multi-country study,^,  designed to investigate the effect of mass biannual azithromycin distribution on all-cause mortality in children aged 1–59 months in sub-Saharan African communities, corroborated these results—although with more modest and credible findings than the trachoma trial. The greatest reduction in all-cause mortality was observed in Niger, the site with the highest baseline mortality, where biannual mass distribution of azithromycin to children aged 1–59 months decreased all-cause mortality by 18% compared with placebo. The results of the MORDOR trial, however, raised many questions about the mechanisms by which azithromycin could have such an effect on child mortality. The direct and indirect (ie, herd protection) therapeutic and chemoprophylactic effects of macrolides against a series of pathogens (either carried asymptomatically or overtly causing disease), their immunomodulatory benefits, or their effect on the human microbiome by promoting a so-called protective composition (ie, against superinfections), are all plausible explanations; the contributions of which remain a matter of scientific speculation. There were high expectations of the MORDOR trial to clearly establish the necessary mechanisms underlying the effects of mass azithromycin distribution in reducing all-cause mortality in children.

中文翻译：

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阿奇霉素用于儿童生存：挖掘时不要太脏，以免因特定原因导致的死亡率下降。

十年前，埃塞俄比亚沙眼试验的惊人结果出乎意料，这表明阿奇霉素的大量销售具有令人兴奋的潜力，可将儿童全因死亡率显着降低约50％。2018年，大环内酯Oraux浇灌了RéduirelesDécèsavec un Oeil sur laRésistance（MORDOR）多国研究^， 该研究旨在调查撒哈拉以南非洲社区中每半年两次阿奇霉素的分布对1至59个月大儿童全因死亡率的影响，证实了这些结果，尽管比沙眼试验更为适度和可信。尼日尔是全因死亡率下降幅度最大的地区，尼日尔是基线死亡率最高的地点，与安慰剂相比，阿奇霉素在1至59个月大的儿童中每两年一次的质量分布使全因死亡率降低了18％。然而，MORDOR试验的结果提出了许多关于阿奇霉素可能对儿童死亡率产生这种影响的机制的疑问。直接和间接（即，大环内酯类药物对一系列病原体（无症状或明显引起疾病）的治疗和化学预防作用，其免疫调节作用或通过促进所谓的保护性组合物（即针对超级感染）对人类微生物组的作用，都是合理的解释；其贡献仍然是科学推测的问题。对MORDOR试验寄予很高的期望，以明确建立潜在的阿奇霉素分布在降低儿童全因死亡率中的作用基础。其贡献仍然是科学推测的问题。对MORDOR试验寄予很高的期望，以明确建立潜在的阿奇霉素分布在降低儿童全因死亡率中的作用基础。其贡献仍然是科学推测的问题。对MORDOR试验寄予很高的期望，以明确建立潜在的阿奇霉素分布在降低儿童全因死亡率中的作用基础。