Targeted Antibiotics for Trachoma: A Cluster-Randomized Trial
| Autor: | E. Kelly Callahan, Ambahun Chernet, Travis C. Porco, Benjamin F. Arnold, Solomon Aragie, Dagnachew Hailu, Adane Dagnew, Scott D. Nash, Jeremy D. Keenan, Thomas M. Lietman, Zerihun Tadesse, Dionna M Wittberg, Taye Zeru, Mahteme Haile, Jason S Melo |
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| Rok vydání: | 2021 |
| Předmět: |
Antibiotics
Chlamydia trachomatis antibacterial agents chlamydia Azithromycin Medical and Health Sciences Gonorrhea 0302 clinical medicine Prevalence 030212 general & internal medicine Child Pediatric mass drug administration education.field_of_study Chlamydia Absolute risk reduction Biological Sciences Anti-Bacterial Agents Infectious Diseases Trachoma Child Preschool 6.1 Pharmaceuticals HIV/AIDS Infection medicine.drug Microbiology (medical) medicine.medical_specialty medicine.drug_class Clinical Trials and Supportive Activities 030231 tropical medicine Population Microbiology 03 medical and health sciences Clinical Research Internal medicine medicine Humans Preschool education Mass drug administration Eye Disease and Disorders of Vision business.industry Infant medicine.disease Confidence interval Major Articles and Commentaries Africa Sexually Transmitted Infections business |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 73, iss 6 Clin Infect Dis |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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