A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia.
OBJECTIVE
Trachomatous trichiasis frequently returns following surgery. Several factors may promote recurrence: preoperative disease severity, surgeon ability, surgical procedure, healing responses, and infection. This study investigates whether enhanced control of infection, both of Chlamydia trachomatis and other bacteria, with azithromycin can improve surgical outcome in a trachoma control programme.


METHODS
Individuals with trachomatous trichiasis were examined and operated. After surgery patients were randomised to the azithromycin or control group. The azithromycin group and children in their household were given a dose of azithromycin. Antibiotic treatment was repeated at 6 months. All patients were reassessed at 6 months and 12 months. Samples were collected for C trachomatis polymerase chain reaction and general microbiology at each examination.


RESULTS
451 patients were enrolled. 426 (94%) were reassessed at 1 year, of whom 176 (41.3%) had one or more lashes touching the eye and 84 (19.7%) had five or more lashes. There was no difference in trichiasis recurrence between the azithromycin and control group. Recurrent trichiasis was significantly associated with more severe preoperative trichiasis, bacterial infection, and severe conjunctival inflammation at 12 months. Significant variability in outcome was found between surgeons. Visual acuity and symptoms significantly improved following surgery.


CONCLUSIONS
In this setting, with a low prevalence of active trachoma, azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme. Audit of trichiasis surgery should be routine.
Burton
M J
MJ
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. matthew.burton@lshtm.ac.uk.
Kinteh
F
F
Jallow
O
O
Sillah
A
A
Bah
M
M
Faye
M
M
Aryee
E A N
EA
Ikumapayi
U N
UN
Alexander
N D E
ND
Adegbola
R A
RA
Faal
H
H
Mabey
D C W
DC
Foster
A
A
Johnson
G J
GJ
Bailey
R L
RL
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D003228:Conjunctiva / Q000382:microbiology; D003231:Conjunctivitis / Q000150:complications / Q000382:microbiology; D018450:Disease Progression; D015818:Eye Infections, Bacterial / Q000150:complications / Q000517:prevention & control; D005140:Eyelashes; D005141:Eyelid Diseases / Q000382:microbiology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia; D006201:Hair Diseases / Q000382:microbiology / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D055502:Secondary Prevention; D012720:Severity of Illness Index; D014141:Trachoma / Q000150:complications / Q000517:prevention & control* / Q000601:surgery
D000900:Anti-Bacterial Agents; D017963:Azithromycin