A targeted, single-dose azithromycin strategy for trachoma.
OBJECTIVE
To evaluate the impact of treating children with acute trachoma and their contacts with oral azithromycin.


METHODS
Open, uncontrolled, prospective evaluation of a community-based treatment strategy.


METHODS
Central Australian semi-desert Aboriginal community (1995-1996).


METHODS
216 school- and pre-schoolchildren aged 6 months and up to 15 years.


METHODS
All children with acute trachoma and their contacts (co-resident siblings aged between 6 months and 15 years) received single-dose oral azithromycin suspension (20 mg/kg, to a maximum of 1000 mg).


METHODS
Prevalence of acute trachoma (World Health Organization trachoma diagnostic criteria).


RESULTS
Trachoma prevalence at baseline was 42% (71/169) and 55% (18/33) for schoolchildren and pre-schoolchildren, respectively: 103 schoolchildren and 21 pre-schoolchildren, comprising 77 with follicular trachoma and their 47 contacts, were treated with azithromycin over an 8-week period. Acute trachoma prevalence in schoolchildren fell to 22% at 6-8 months (P < 0.0001) and was 31% at 12 months (P < 0.05 compared with baseline). Pre-schoolchildren were followed up for 6 months after treatment, and their trachoma prevalence fell from 55% to 25% (P < 0.05). Further treatment was given to children with trachoma at 12 months, and the point prevalence of trachoma for schoolchildren at 24 months was 34%.


CONCLUSIONS
In contrast to mass-treatment strategies, significant reductions in trachoma prevalence at 6 months were achieved by screening 35% of community members (216) and treating 20% (124). The subsequent prevalence increases support the need for more comprehensive treatment programs, including health promotion and efforts to improve living conditions.
Laming
A C
AC
Royal North Shore Hospital, Sydney, NSW.
Currie
B J
BJ
DiFrancesco
M
M
Taylor
H R
HR
Mathews
J D
JD
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D015876:Northern Territory / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D012572:School Health Services; D014141:Trachoma / Q000188:drug therapy* / Q000208:ethnology; D016896:Treatment Outcome; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
D000900:Anti-Bacterial Agents; D017963:Azithromycin