title: A Cluster-Randomized Trial to Assess the Efficacy of Targeting Trachoma Treatment to Children.
abstract: The World Health Organization recommends annual treatment of entire trachoma-endemic communities, although children typically have a higher load, longer duration, and greater likelihood of infection.
  
  
  
  Forty-eight communities in Matameye, Niger, were randomized to annual oral azithromycin treatment of the entire community or biannual treatment of children aged 0-12 years only. Both children and adults were monitored for ocular chlamydial infection by polymerase chain reaction.
  
  
  
  The prevalence of childhood infection was reduced in the annually treated arm from 21.2% (95% confidence interval [CI], 15.2%-28.0%) at baseline to 5.8% (95% CI, 3.2%-9.0%) at 36 months (P < .001) and in the biannual arm from 20.2% (95% CI, 15.5%-25.3%) to 3.8% (95% CI, 2.2%-6.0%; P < .001). Adult infection in the annual arm was reduced from 1.7% (95% CI, .9%-2.7%) to 0.3% (95% CI, .0%-.7%) and in the biannual arm from 1.2% (95% CI, .5%-2.2%) to 0.0% (95% CI, .0%-.7%; P = .005). The effect of biannual treatment of children compared with annual treatment of the entire community in both children (95% CI, -.04% to .02%) and adults (95% CI, .9%-2.7%) excluded the prespecified noninferiority threshold of 6% (P = .003 and P < .001, respectively).
  
  
  
  Periodic distribution of antibiotics to children in trachoma-endemic communities reduces chlamydial infection in both children and untreated adults, suggesting a form of herd protection. Biannual treatment of children was comparable to (specifically, noninferior to) annual treatment of the entire community, and may offer lower antibiotic use and other logistical advantages.
  
  
  
  NCT00792922.
authors.affiliation: Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger.
authors.forename: Abdou
authors.initials: A
authors.lastname: Amza
authors.affiliation: Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger.
authors.forename: Boubacar
authors.initials: B
authors.lastname: Kadri
authors.affiliation: Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger.
authors.forename: Beido
authors.initials: B
authors.lastname: Nassirou
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.
authors.forename: Sun Y
authors.initials: SY
authors.lastname: Cotter
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bailey
authors.affiliation: Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Mabey
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.|Department of Ophthalmology, University of California, San Francisco, USA.|Epidemiology and Biostatistics, University of California, San Francisco, USA.
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.|Department of Ophthalmology, University of California, San Francisco, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.|Department of Ophthalmology, University of California, San Francisco, USA.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, USA.|Department of Ophthalmology, University of California, San Francisco, USA.|Epidemiology and Biostatistics, University of California, San Francisco, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D013997:Time Factors; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: chlamydia; mass drug administration; trachoma; cluster-randomized trial