Efficacy of oral azithromycin versus topical tetracycline in mass treatment of endemic trachoma.
OBJECTIVE
To compare the impact of mass treatment with oral azithromycin and topical tetracycline on the prevalence of active trachoma.


METHODS
A total of 1803 inhabitants from 106 households of eight Gambian villages were randomized, in pairs, to receive either three doses of azithromycin at weekly intervals, or daily topical tetracycline over 6 weeks. Ocular examinations were conducted before treatment, and 2, 6 and 12 months after treatment.


RESULTS
Prior to treatment, 16% of the study participants had active trachoma. Two months after treatment, the prevalence of trachoma was 4.6% and 5.1% in the azithromycin and the tetracycline groups, respectively (adjusted odds ratio (OR) = 1.09; 95% confidence interval (CI) = 0.53, 2.02). Subsequently, the prevalence rose to 16% in the tetracycline group, while remaining at 7.7% in the azithromycin group (adjusted OR at 12 months = 0.52; 95% CI = 0.34, 0.80). At 12 months post-treatment, there were fewer new prevalent cases in the azithromycin group, and trachoma resolution was significantly better for this group (adjusted OR = 2.02; 95% CI = 1.42, 3.50).


CONCLUSIONS
Oral azithromycin therefore appears to offer a means for controlling blinding trachoma. It is easy to administer and higher coverages may be possible than have been achieved hitherto.
Fraser-Hurt
N
N
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, England.
Bailey
R L
RL
Cousens
S
S
Mabey
D
D
Faal
H
H
Mabey
D C
DC
D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004341:Drug Evaluation; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D013754:Tetracyclines / Q000008:administration & dosage / Q000627:therapeutic use*; D014141:Trachoma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013754:Tetracyclines; D017963:Azithromycin