Mass azithromycin distribution and antibiotic resistance in the gut and nasopharynx: a cluster-randomized trial.

Name: Αlpha¹ Rigor Record — Mass azithromycin distribution and antibiotic resistance in the gut and nasopharynx: a cluster-randomized trial.
Item: Mass azithromycin distribution and antibiotic resistance in the gut and nasopharynx: a cluster-randomized trial.
Rating: 100
Author: Αlpha¹

Doan T, Yan D, Arzika AM, Abdou A, Maliki R, Aichatou B, Bello IM, Beidi D, Galo N, Harouna N, Karamba AM, Mahamadou S, Abarchi M, Ibrahim A, Zhong L, Chen C, Liu Y, Yu D, Abraham T, Cheng AS, Peterson B, Oldenburg CE, Porco TC, Arnold BF, Hinterwirth A, Lebas E, O'Brien KS, Lietman TM

Paper source

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Αlpha¹ Rigor Review — 2.75★ (Weak), 0 critical, 2 high issues for “Mass azithromycin distribution and antibiotic resistance in the gut and nasopharynx: a cluster-randomized trial.”

Links back to this Rigor Record.

Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · August 15, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

2.75 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×4−2★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 8 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.

Problems surfaced3 types

Numerical inconsistencies1

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Overstated conclusions1

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Conclusions only partially backed by the presented evidenceAssessed

Broken references and links1

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted cluster-randomized trial with rigorous design, clear reporting of ethics, data availability, and statistical methods. Minor reporting gaps include lack of explicit outlier handling, assumptions verification, and code sharing, plus a few copyedit issues.

Both reviewers independently scored all dimensions as pass with high confidence; no divergence. The statistics verification recomputed 3 tests consistently, but coverage is limited to tests with test statistics/df or effect estimates with CIs; threshold-only p-values and resampling-based p-values were not machine-verified. The citation check flagged one reference (Dryad DOI) as not found in registry, which is a data availability link rather than a citation to prior literature.

9 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

Recomputed 3 tests: 3 consistent, 0 inconsistent; 3 via agent-written checks.

4 integrity concerns flagged (0 high).

Reporting

Eight Dimensions8 pass

The introduction cites prior trials (MORDOR, AVENIR) and WHO guidelines, establishing the context and the need to balance mortality benefits with AMR risk. The rationale for the study is logical, linking the premise to the objective of evaluating AMR selection. Limitations of prior research are addressed in the discussion, such as the lack of placebo arms in some prior studies and the potential for AMR spillover.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise by citing prior research on azithromycin MDA and mortality, and the rationale for studying AMR is well-articulated.

Evidence

direct quote[Introduction, paragraph 1]

“Mass drug distribution (MDA) of broad-spectrum antibiotics to preschool children prevents mortality of those under 5 years old in some regions in sub-Saharan Africa – .”