Targeted Antibiotics for Trachoma: A Cluster-Randomized Trial.
Africa
antibacterial agents
chlamydia
mass drug administration
trachoma
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
15 09 2021
15 09 2021
Historique:
received:
27
10
2020
pubmed:
7
3
2021
medline:
8
10
2021
entrez:
6
3
2021
Statut:
ppublish
Résumé
Current guidelines recommend community-wide mass azithromycin for trachoma, but a targeted treatment strategy could reduce the volume of antibiotics required. In total, 48 Ethiopian communities were randomized to mass, targeted, or delayed azithromycin distributions. In the targeted arm, only children aged 6 months to 5 years with evidence of ocular chlamydia received azithromycin, distributed thrice over the following year. The primary outcome was ocular chlamydia at months 12 and 24, comparing the targeted and delayed arms (0-5 year-olds, superiority analysis) and the targeted and mass azithromycin arms (8-12 year-olds, noninferiority analysis, 10% noninferiority margin). At baseline, the mean prevalence of ocular chlamydia in the 3 arms ranged from 7% to 9% among 0-5 year-olds and from 3% to 9% among 8-12 year-olds. Averaged across months 12-24, the mean prevalence of ocular chlamydia among 0-5 year-olds was 16.7% (95% confidence interval [CI]: 9.0%-24.4%) in the targeted arm and 22.3% (95% CI: 11.1%-33.6%) in the delayed arm (P = .61). The final mean prevalence of ocular chlamydia among 8-12 year-olds was 13.5% (95% CI: 7.9%-19.1%) in the targeted arm and 5.5% (95% CI: 0.3%-10.7%) in the mass treatment arm (adjusted risk difference 8.5 percentage points [pp] higher in the targeted arm, 95% CI: 0.9 pp-16.1 pp higher). Antibiotic treatments targeted to infected preschool children did not result in significantly less ocular chlamydia infections compared with untreated communities and did not meet noninferiority criteria relative to mass azithromycin distributions. Targeted approaches may require treatment of a broader segment of the population in areas with hyperendemic trachoma.
Sections du résumé
BACKGROUND
Current guidelines recommend community-wide mass azithromycin for trachoma, but a targeted treatment strategy could reduce the volume of antibiotics required.
METHODS
In total, 48 Ethiopian communities were randomized to mass, targeted, or delayed azithromycin distributions. In the targeted arm, only children aged 6 months to 5 years with evidence of ocular chlamydia received azithromycin, distributed thrice over the following year. The primary outcome was ocular chlamydia at months 12 and 24, comparing the targeted and delayed arms (0-5 year-olds, superiority analysis) and the targeted and mass azithromycin arms (8-12 year-olds, noninferiority analysis, 10% noninferiority margin).
RESULTS
At baseline, the mean prevalence of ocular chlamydia in the 3 arms ranged from 7% to 9% among 0-5 year-olds and from 3% to 9% among 8-12 year-olds. Averaged across months 12-24, the mean prevalence of ocular chlamydia among 0-5 year-olds was 16.7% (95% confidence interval [CI]: 9.0%-24.4%) in the targeted arm and 22.3% (95% CI: 11.1%-33.6%) in the delayed arm (P = .61). The final mean prevalence of ocular chlamydia among 8-12 year-olds was 13.5% (95% CI: 7.9%-19.1%) in the targeted arm and 5.5% (95% CI: 0.3%-10.7%) in the mass treatment arm (adjusted risk difference 8.5 percentage points [pp] higher in the targeted arm, 95% CI: 0.9 pp-16.1 pp higher).
CONCLUSIONS
Antibiotic treatments targeted to infected preschool children did not result in significantly less ocular chlamydia infections compared with untreated communities and did not meet noninferiority criteria relative to mass azithromycin distributions. Targeted approaches may require treatment of a broader segment of the population in areas with hyperendemic trachoma.
Identifiants
pubmed: 33674869
pii: 6155670
doi: 10.1093/cid/ciab193
pmc: PMC8442777
doi:
Substances chimiques
Anti-Bacterial Agents
0
Azithromycin
83905-01-5
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
979-986Subventions
Organisme : NEI NIH HHS
ID : U10 EY023939
Pays : United States
Organisme : NEI NIH HHS
ID : UG1 EY023939
Pays : United States
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
Invest Ophthalmol Vis Sci. 2005 Jan;46(1):83-7
pubmed: 15623758
Nat Med. 1999 May;5(5):572-6
pubmed: 10229236
Lancet. 2005 Apr 9-15;365(9467):1321-8
pubmed: 15823382
JAMA. 2006 Sep 27;296(12):1488-97
pubmed: 17003397
Am J Trop Med Hyg. 2019 Dec;101(6):1286-1295
pubmed: 31549612
Biomed Res Int. 2015;2015:570898
pubmed: 25954753
N Engl J Med. 2004 Nov 4;351(19):1962-71
pubmed: 15525721
Acta Trop. 2007 Jan;101(1):40-53
pubmed: 17239332
Int J Epidemiol. 2018 Feb 1;47(1):332-347
pubmed: 29106568
Lancet. 2012 Jan 14;379(9811):143-51
pubmed: 22192488
Int J Epidemiol. 2017 Aug 1;46(4):1251-1276
pubmed: 28449030
Int Health. 2011 Jun;3(2):75-84
pubmed: 21785663
PLoS Med. 2018 Aug 14;15(8):e1002633
pubmed: 30106956
Bull World Health Organ. 2001;79(3):201-7
pubmed: 11285663
Med J Aust. 2000 Feb 21;172(4):163-6
pubmed: 10772587
PLoS Negl Trop Dis. 2020 May 18;14(5):e0008226
pubmed: 32421719
Lancet. 2009 Mar 28;373(9669):1111-8
pubmed: 19329003
Lancet. 2003 Jul 19;362(9379):198-204
pubmed: 12885481
Bull World Health Organ. 2001;79(3):194-200
pubmed: 11285662
Epidemiol Infect. 1999 Dec;123(3):479-86
pubmed: 10694161
BMJ Open. 2021 Feb 22;11(2):e039529
pubmed: 33619183