Mass Antibiotic Distribution and Its Effect on Trachoma

Abstract

International Child Health| September 01 2006 Mass Antibiotic Distribution and Its Effect on Trachoma AAP Grand Rounds (2006) 16 (3): 31–32. https://doi.org/10.1542/gr.16-3-31-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Mass Antibiotic Distribution and Its Effect on Trachoma. AAP Grand Rounds September 2006; 16 (3): 31–32. https://doi.org/10.1542/gr.16-3-31-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: trachoma Source: Chidambaram JD, Alemayehu W, Melese M, et al. Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma. JAMA. 2006;295:1142–1146; doi:10.1001/jama.295.10.1142 Trachoma is said to be the most important cause of preventable blindness worldwide – accounting for 15% of blindness and affecting approximately 6 million people1 – and ranks second only to cataracts as a cause of blindness. An international, multicenter collaboration sought to investigate the role of antibiotics and whether trachoma returns after a single mass antibiotic distribution. Multiple villages in Ethiopia were followed for 24 months, from 2003 to 2005, after receipt of a single oral dose of azithromycin in April 2003. The antibiotic was administered to all residents over 1 year of age at 20 mg/kg as a directly observed therapy. Children aged 1–5 years were monitored since this age group has a high prevalence of infection2 and may form the core group for transmission.3 Five hundred fifteen children were examined for ocular chlamydial infection at baseline. Prior to treatment, the mean prevalence of infection was 44%. By 2 months after treatment, the percentage had decreased to 5.1%. By 24 months after treatment, the mean prevalence of infection had risen to 11%. The study demonstrated that a single antibiotic treatment significantly reduced infection rates, but infection eventually returned in some children and that periodic treatments are required. Dr. Dinerman has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Trachoma is a chronic keratoconjunctivitis caused by repeat infection with the ocular serotypes A, B, Ba, and C of Chlamydia trachomatis.4 The infection is acquired by contact with infected fingers, fomites, or flies. Children from disadvantaged communities in developing countries typically develop trachoma between the ages of 2–5 years. Active trachoma is characterized by follicular inflammation; that is, the development of 5 or more round swellings in the central portion of the upper tarsal conjunctiva. Repeat infections lead to upper lid fibrosis and contraction at the tarsal plate resulting in entropion, an abnormal inward rotation of the eyelid. As eyelashes turn inward they cause chronic corneal abrasions eventually leading to corneal scarring and opacification, a disease known as trachomatous triachiasis. Corneal opacification may be prevented through eyelid surgery. Surgical procedures for entropion correction include tarsal rotation, eversion splinting, and tarsal advance and rotations.5 This study suggests that although a single mass antibiotic distribution can reduce the burden of ocular chlamydia infection, repeat treatment is necessary since infection returns in some children after a single mass treatment. WHO judiciously recommends multiple mass distributions of azithromycin for trachoma prevention.6 The Alliance for the Global Elimination of Trachoma set the year 2020 as the target for the elimination of trachoma. Progress toward reducing the global burden of trachoma will require political and financial support, community education and development, improved access... You do not currently have access to this content.