Discussion
ETEC diarrhea, intestinal infections, infections, reinfections, ETEC
INFECTIONS, INTESTINAL INFECTIONS
The ELICIT trial administered single-dose azithromycin plus or minus nitazoxanide quarterly to infants under the hypothesis that antibiotic treatment of the intestinal infections associated with poor growth could reduce child stunting. In the primary analysis no effect on childhood growth or stunting was seen at 18 months of age [First, we did observe a clear and large effect of azithromycin on It was surprising to not see an effect of azithromycin against ETEC, as this antibiotic clearly has shown an effect on ETEC diarrhea [Therefore the underlying hypothesis of the ELICIT study was not able to be completely tested, as it remains possible that a better antimicrobial regimen that better and more durably reduces the pathogens associated with poor growth (There was a suggestion of improved weight-for-age Z score and length-for-age Z score in the subset of children infected with Limitations of this work include that our sampling frame only tested stools at 6 monthly time points so we do not know the kinetics of how long the azithromycin effect lasted or how quickly reinfections occurred. Additionally, the PCR approach could detect prolonged shedding of pathogens killed after antibiotics which could also obscure an antimicrobial effect.In sum, the antimicrobial regimen tested in this study was not as effective as expected in treating the candidate enteropathogens. We do not believe that periodic azithromycin mass drug administration is the proper tool to improve childhood growth, at least in this setting, since the aggressive regimens of antimicrobial required to reduce enteric infections would carry complex risks and antimicrobial resistance. The suggestion that reducing 