@article{28549, keywords = {Trachoma, Single mass antibiotic distribution}, author = {Lakew T and Alemayehu W and Melese M and Yi E and House J and Hong KC and Zhou Z and Ray K and Porco T and Gaynor B and Lietman TM and Keenan JD}, title = {Importance of coverage and endemicity on the return of infectious trachoma after a single mass antibiotic distribution.}, abstract = {

BACKGROUND: As part of the SAFE strategy, mass antibiotic treatments are useful in controlling the ocular strains of chlamydia that cause trachoma. The World Health Organization recommends treating at least 80% of individuals per community. However, the role of antibiotic coverage for trachoma control has been poorly characterized.

METHODOLOGY/PRINCIPAL FINDINGS: In a collection of cluster-randomized clinical trials, mass oral azithromycin was administered to 40 villages in Ethiopia. The village prevalence of ocular chlamydia was determined before treatment, and at two and six months post-treatment. The mean prevalence of ocular chlamydia was 48.9% (95% CI 42.8 to 55.0%) before mass treatments, decreased to 5.4% (95% CI 3.9 to 7.0%) at two months after treatments (p<0.0001), and returned to 7.9% (95% CI 5.4 to 10.4%) by six months after treatment (p = 0.03). Antibiotic coverage ranged from 73.9% to 100%, with a mean of 90.6%. In multivariate regression models, chlamydial prevalence two months after treatment was associated with baseline infection (p<0.0001) and antibiotic coverage (p = 0.007). However, by six months after treatment, chlamydial prevalence was associated only with baseline infection (p<0.0001), but not coverage (p = 0.31).

CONCLUSIONS/SIGNIFICANCE: In post-hoc analyses of a large clinical trial, the amount of endemic chlamydial infection was a strong predictor of chlamydial infection after mass antibiotic treatments. Antibiotic coverage was an important short-term predictor of chlamydial infection, but no longer predicted infection by six months after mass antibiotic treatments. A wider range of antibiotic coverage than found in this study might allow an assessment of a more subtle association.

}, year = {2009}, journal = {PLoS neglected tropical diseases}, volume = {3}, pages = {e507}, issn = {1935-2735}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724711/pdf/pntd.0000507.pdf}, doi = {10.1371/journal.pntd.0000507}, language = {eng}, }