Rethink needed on how communities affected with trachoma are treated

One or two rounds of high coverage mass treatment with azithromycin, rather than the annual treatment recommended by the World Health Organisation, may be enough to eliminate the eye disease trachoma in communities with moderate levels of infection.

The London School of Hygiene & Tropical Medicine's Trachoma Group has written a letter to the New England Journal of Medicine, outlining the findings of a trial some of its members carried out in Kahe Mpya, Tanzania, and calling for a re-think on the way communities affected with trachoma are treated.

As part of the trial, 97.6% of residents were treated with single-dose azithromycin and the prevalence of trachoma fell from 9.5% to 0.1% after two years. A second round of mass treatment was carried out at 24 months, and residents were examined at 42 and 60 months. Those with active trachoma were offered a course of tetracycline eye ointment. After 60 months, three years after the second round of mass treatment, trachoma DNA was not detected in the conjunctiva of any of the 859 patients swabbed, suggesting that the infection had been eliminated.

The World Health Organisation currently recommends three years of annual mass azithromycin treatment before reassessment in communities where prevalence in children aged between one and nine years is 10% or greater.

Dr. Anthony Solomon, lead author of the letter, comments 'Had WHO recommendations on antibiotic use been followed, three or possibly six annual rounds of mass treatment would have been offered in this community, whereas our data suggest that one round was sufficient. The less antibiotic we can use in each community, the more people we'll be able to use donated antibiotic for, and the lower the likelihood of the emergence of antibiotic-resistant strains'.