title: Association of community antibiotic consumption with clinically active trachoma in rural Ethiopia.
abstract: Community antibiotic utilization and its relationship with trachoma has been poorly characterized in areas with endemic trachoma. A survey of all drug-dispensing facilities in an area of rural Ethiopia was conducted. Antibiotic use was calculated using both retrospective and prospective methodology, and expressed as defined daily doses (DDDs). Overall antibiotic consumption estimates ranged from 2.91 to 3.07 DDDs per 1000 person days. Macrolide antibiotics accounted for 0.01 to 0.02 DDDs per 1000 person days. Each additional DDD of antibiotic use per 1000 person days was associated with a 15.0% (95% CI -19.7 to -10.3) decrease in the prevalence of clinically active trachoma among children under 10 years of age after adjusting for age, gender, altitude and the distance to nearest town. Increased background community antibiotic use may therefore be an aspect of socioeconomic development that can partially explain why trachoma prevalence has decreased in some areas in the absence of a trachoma program. The low volume of macrolide consumption in this area suggests that selection for nasopharyngeal pneumococcal macrolide resistance after mass azithromycin treatments likely has little clinical significance.
authors.affiliation: The Carter Center Ethiopia, Bole K.K., Kebele 05, H.No. 956, P.O. Box 13373, Addis Ababa, Ethiopia.
authors.forename: Berhan
authors.initials: B
authors.lastname: Ayele
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Belay
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.forename: Abayneh
authors.initials: A
authors.lastname: Amere
authors.forename: Yared
authors.initials: Y
authors.lastname: Assefa
authors.forename: Dereje
authors.initials: D
authors.lastname: Habte
authors.forename: Allison R
authors.initials: AR
authors.lastname: Loh
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan