title: Adverse and beneficial secondary effects of mass treatment with azithromycin to eliminate blindness due to trachoma in Nepal.
abstract: Mass administration of azithromycin to eliminate blindness due to trachoma has raised concerns regarding the emergence of antimicrobial resistance. During 2000, we compared the antimicrobial resistance of nasopharyngeal pneumococcal isolates recovered from and the prevalence of impetigo, respiratory symptoms, and diarrhea among 458 children in Nepal before and after mass administration of azithromycin. No azithromycin-resistant pneumococci were isolated except from 4.3% of children who had received azithromycin during 2 previous mass treatments (P<.001). There were decreases in the prevalence of impetigo (from 14% to 6% of subjects; adjusted odds ratio [OR], 0.41; 95% confidence interval [CI], 0.21-0.80) and diarrhea (from 32% to 11%; adjusted OR, 0.26; 95% CI, 0.14-0.43) 10 days after azithromycin treatment. The absence of macrolide-resistant isolates after 1 mass treatment with azithromycin is encouraging, although the recovery of azithromycin-resistant isolates after 2 mass treatments suggests the need for resistance monitoring when multiple rounds of antimicrobial treatment are given.
authors.affiliation: Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. afry@cdc.gov
authors.forename: A M
authors.initials: AM
authors.lastname: Fry
authors.forename: H C
authors.initials: HC
authors.lastname: Jha
authors.forename: T M
authors.initials: TM
authors.lastname: Lietman
authors.forename: J S P
authors.initials: JS
authors.lastname: Chaudhary
authors.forename: R C
authors.initials: RC
authors.lastname: Bhatta
authors.forename: J
authors.initials: J
authors.lastname: Elliott
authors.forename: T
authors.initials: T
authors.lastname: Hyde
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
authors.forename: B
authors.initials: B
authors.lastname: Gaynor
authors.forename: S F
authors.initials: SF
authors.lastname: Dowell
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D001766:Blindness / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000187:drug effects; D024881:Drug Resistance, Bacterial; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000209:etiology; D013296:Streptococcus pneumoniae / Q000187:drug effects; D014141:Trachoma / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin