Azithromycin in control of trachoma
Azithromycin in control of trachoma
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DOI：
10.1016/s0140-6736(98)12387-5
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发表时间：
1999-08-21
期刊：
影响因子：
168.9
通讯作者：
Faal, H
中科院分区：
文献类型：
--
作者：
Schachter, J;West, SK;Faal, H
沙眼是可预防失明的主要原因。预防沙眼致盲的规划以社区范围的局部四环素治疗为基础。我们评估了社区范围内阿奇霉素治疗控制沙眼的潜力。方法对埃及、冈比亚和坦桑尼亚沙眼流行区的村庄进行1-10岁儿童沙眼发病率配对。村庄被随机分配到社区范围内口服阿奇霉素治疗（三剂，间隔1周）或1%外用四环素治疗（每天一次，持续6周）。临床检查分别在治疗后基线、2-4.5个月和12-14个月进行。采用连接酶链反应（LCR）鉴定沙眼衣原体。分析的目的是治疗。采用单因素比较和多因素分析比较结果。LCR阳性与临床严重程度相关，但约30%的埃及和冈比亚村民无活动性疾病为LCR阳性。全村LCR阳性率从16.5%（坦桑尼亚）到43.6%（埃及）不等。除埃及四环素治疗村外，治疗依从性均在90%以上。在最初LCR阳性的参与者中，接受至少一次阿奇霉素剂量的924人中有866人（95%）在随访时呈阴性，接受28天或更长时间外用四环素的587人中有482人（82%）在随访时呈阴性。1年后，两种治疗的全村LCR阳性率均显著低于基线水平；阿奇霉素组的降幅大于四环素组（埃及为93%对77%，冈比亚为78%对66%，坦桑尼亚为64%对55%）。同样，服用阿奇霉素后，临床活性下降幅度更大。在多变量分析中，与1年时LCR阳性相关的因素是：未使用阿奇霉素；年龄在10岁以下；基线LCR阳性。结论社区范围内口服阿奇霉素治疗可显著降低沙眼原体感染和沙眼流行地区的临床发病率，可能是控制沙眼的重要途径。
Background Trachoma is the leading cause of preventable blindness. Programmes to prevent blindness due to trachoma are based on community-wide treatment with topical tetracycline. We assessed the potential of community-wide azithromycin treatment for trachoma control.Methods Pairs of villages in trachoma endemic areas of Egypt, The Gambia, and Tanzania were matched on trachoma rates in 1-10-year-old children. Villages were randomly assigned community-wide oral azithromycin treatment (three doses with intervals of 1 week) or treatment with 1% topical tetracycline (once daily for 6 weeks). Clinical examinations were done at baseline, 2-4.5 months, and 12-14 months after treatment. Chlamydia trachomatitis was identified by ligase chain reaction (LCR). Analyses were by intention to treat. Univariate comparisons and multivariate analyses were used to compare outcomes.Findings LCR positivity was correlated with clinical severity, but about 30% of Egyptian and Gambian villagers with no active disease were LCR positive. Village-wide LCR positivity ranged from 16.5% (Tanzania) to 43.6% (Egypt). Treatment compliance was over 90% except in the tetracycline treatment village in Egypt. Of the participants initially LCR positive, 866 (95%) of 924 who received at least one azithromycin dose and 482 (82%) of 587 who received 28 days or more topical tetracycline, were negative at follow-up. At 1 year, village-wide LCR positivity rates were substantially lower than at baseline with both treatments; the decreases were greater with azithromycin than with tetracycline (93% vs 77% in Egypt, 78 vs 66% in The Gambia, 64 vs 55% in Tanzania). Similarly, greater reduction in clinical activity occurred after azithromycin. In multivariate analyses, factors associated with being LCR positive at 1 year were: not receiving azithromycin; age under 10 years; and LCR positivity at baseline.Interpretation Community-wide treatment with oral azithromycin markedly reduces C trachomatis infection and clinical trachoma in endemic areas and may be an important approach to control of trachoma.