One drug to treat them all: ethical implications of the MORDOR trial of mass antibiotic administration to reduce child mortality

The trial authors did not specifically report changes in antibiotic resistance in bacterial species in the study population (this work is ongoing), although previous studies have reported increases in carriage of macrolide-resistant Streptococcus pneumoniae and Escherichia coli in children following mass azithromycin administration for trachoma control [2-6]. [...]although there is good reason to believe that mass azithromycin treatment would lead to increased levels of bacterial resistance, the clinical implications and public health impact are currently unknown. To diminish infant and child mortality; To ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care; To combat disease and malnutrition, including within the framework of primary health care, through, inter alia, the application of readily available technology and through the provision of adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution To the extent that mass antibiotic administration is a readily available technology that turns out to have a scientifically demonstrable effect in preventing childhood mortality, the international human rights framework seems to confer at least a prima facie duty to provide children access to that technology. In our view these include mechanisms to monitor and assure the safety of mass antibiotic administration, both in terms of adverse drug reactions and emergence of antibiotic resistance, as well as measures to reduce dependence on mass antibiotic administration, including improvements in sanitation, water quality, immunisation coverage and provision of adequate health care. A global ethics perspective, though often overlooked, highlights the complex challenges posed by antimicrobial resistance and the need for integrated, cross-sectoral approaches to infectious disease control, global antimicrobial stewardship, sanitation and universal health care, while providing a framework for action that respects the rights of both individuals and the global community. 1 Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 2 London School of Hygiene & Tropical Medicine, London, United Kingdom 3 Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore