A targeted, single-dose azithromycin strategy for trachoma

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.