ABSTRACT
OBJECTIVE: To evaluate the impact of treating children with acute trachoma and their contacts with oral azithromycin. DESIGN: Open, uncontrolled, prospective evaluation of a community-based treatment strategy. SETTING: Central Australian semi-desert Aboriginal community (1995-1996). PARTICIPANTS: 216 school- and pre-schoolchildren aged 6 months and up to 15 years. INTERVENTION: All children with acute trachoma and their contacts (co-resident siblings aged between 6 months and 15 years) received single-dose oral azithromycin suspension (20 mg/kg, to a maximum of 1000 mg). MAIN OUTCOME MEASURE: Prevalence of acute trachoma (World Health Organization trachoma diagnostic criteria). RESULTS: Trachoma prevalence at baseline was 42% (71/169) and 55% (18/33) for schoolchildren and pre-schoolchildren, respectively: 103 schoolchildren and 21 pre-schoolchildren, comprising 77 with follicular trachoma and their 47 contacts, were treated with azithromycin over an 8-week period. Acute trachoma prevalence in schoolchildren fell to 22% at 6-8 months (P < 0.0001) and was 31% at 12 months (P < 0.05 compared with baseline). Pre-schoolchildren were followed up for 6 months after treatment, and their trachoma prevalence fell from 55% to 25% (P < 0.05). Further treatment was given to children with trachoma at 12 months, and the point prevalence of trachoma for schoolchildren at 24 months was 34%. CONCLUSIONS: In contrast to mass-treatment strategies, significant reductions in trachoma prevalence at 6 months were achieved by screening 35% of community members (216) and treating 20% (124). The subsequent prevalence increases support the need for more comprehensive treatment programs, including health promotion and efforts to improve living conditions.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Azithromycin/administration & dosage , Native Hawaiian or Other Pacific Islander , Trachoma/drug therapy , Acute Disease , Administration, Oral , Adolescent , Child , Child, Preschool , Humans , Infant , Native Hawaiian or Other Pacific Islander/statistics & numerical data , Northern Territory/epidemiology , Population Surveillance , Prevalence , Prospective Studies , Rural Health/statistics & numerical data , School Health Services , Trachoma/ethnology , Treatment OutcomeSubject(s)
Chlamydia trachomatis/genetics , DNA, Bacterial/isolation & purification , Mass Screening/methods , Polymerase Chain Reaction/methods , Reagent Kits, Diagnostic , Trachoma/diagnosis , Australia , Child , Diagnosis, Differential , Humans , Sensitivity and Specificity , Trachoma/prevention & controlABSTRACT
In February 1995, single-dose azithromycin was given to children with trachoma and their household contacts who were children. For children with trachoma, rates of carriage of pneumococci immediately before treatment with azithromycin and 2-3 weeks, 2 months, and 6 months after treatment were 68% (54 of 79), 29% (11 of 38), 78% (29 of 37), and 87% (34 of 39), respectively. The proportion of carriage-positive children with azithromycin-resistant Streptococcus pneumoniae strains was 1 of 54 (1.9%) before treatment and then 6 of 11 (54.5%), 10 of 29 (34.5%), and 2 of 34 (5.9%) at follow-up visits. The profile of pneumococcal serotypes changed after azithromycin treatment. Azithromycin-resistant strains (serotypes 10F, 23A, and 45) were isolated from 1 (1.3%) of 79 pretreatment swab specimens, from 16 (21.3%) of 75 swab specimens collected up to 2 months after treatment, and from 2 (6%) of 32 obtained 6 months after treatment. Mathematical modeling showed a more rapid appearance of azithromycin-resistant pneumococcal strains in previously colonized children than in previously noncolonized children. Thus, it appears that the selective effect of azithromycin allowed the growth and transmission of preexisting azithromycin-resistant strains. More research is needed to clarify the clinical relevance and implications of azithromycin use.
