DISCUSSION
obesity, weight gain, early-life, infantile hypertrophic pyloric stenosis
OBESITY, CHILDHOOD OBESITY, ADVERSE EVENTS, TRACHOMA, PYLORIC STENOSIS
We found no evidence to support a growth-promoting effect of azithromycin when administered to neonates by 6 months of age. The sample size was large, and the trial was powered to detect very small effect sizes. Previous studies have shown growth-promoting effects of antibiotics in a meta-analysis of randomized controlled trial of children >1 month of age, particularly for weight gain.Some observational analyses have suggested that early-life antibiotic exposure may be linked to obesity in children in higher-income settings.Some evidence has suggested that antibiotic exposure during the first week of life led to decreased growth compared with later administration.The use of antibiotics during early infancy in the absence of a clear clinical indication, as in studies for the prevention of childhood mortality, must be balanced with potential risk of adverse events. As previously mentioned, observational studies have suggested that early-life exposure to macrolides may increase risk of infantile hypertrophic pyloric stenosis. The parent trial found no evidence of an increased risk of pyloric stenosis.This study had some limitations. Previous evidence has suggested a short-term but no longer-term effect of azithromycin on weight gain in children aged 1 to 59 months.We found no evidence that early life azithromycin distribution increases linear growth or weight gain in this randomized controlled trial of azithromycin compared with placebo administered to neonates aged 8 to 27 days of age. Although some observational analyses have suggested that early-life antibiotic administration may cause weight gain and predispose children to obesity, the results of the present study do not support that hypothesis. The use of azithromycin in child survival and trachoma programs is unlikely to contribute to childhood obesity, and growth promoting effects are unlikely to be a major contributor of azithromycin for improving infant survival.