Randomized Trial of Community Treatment With Azithromycin and Ivermectin Mass Drug Administration for Control of Scabies and Impetigo
Randomized Trial of Community Treatment With Azithromycin and Ivermectin Mass Drug Administration for Control of Scabies and Impetigo
复制标题
DOI：
10.1093/cid/ciy574
复制
发表时间：
2019-03-15
影响因子：
11.8
通讯作者：
Steer, Andrew C.
中科院分区：
文献类型：
--
作者：
Marks, Michael;Toloka, Hilary;Steer, Andrew C.
疥疮是许多国家的公共卫生问题，脓疱病及其并发症造成重要后果。伊维菌素为基础的大规模药物管理（MDA）降低疥疮的患病率，并在较小程度上，脓疱。我们研究了共同管理阿奇霉素的流行性脓疱病和抗菌药物resistance.Methods六个社区的影响随机接受伊维菌素为基础的MDA或伊维菌素为基础的MDA与阿奇霉素共同管理。我们测量了基线和12个月时疥疮和脓疱病的患病率。我们在基线、3个月和12个月收集脓疱病皮损拭子检测抗菌药物耐药性。结果在基线时，疥疮和脓疱病患病率在伊维菌素单药治疗组分别为11.8%和10.1%，在联合治疗组分别为9.2%和12.1%。单用伊维菌素组的患病率下降至1.0%和2.5%，联合治疗组的患病率下降至0.7%和3.3%。检出的含金黄色葡萄球菌的脓疱性病变的比例没有变化（基线时为80%，12个月时为86%;两组之间无显著差异），但含有化脓性链球菌的比例显著下降（63% vs 23%，P <0.01）。3个月时，53%（8/15）的S.金黄色葡萄球菌分离株大环内酯耐药的联合治疗臂，但没有耐药菌株（0/13）检测到在12 months.Conclusions阿奇霉素与伊维菌素的共同管理导致类似的减少疥疮和脓疱病的患病率相比，伊维菌素单独。含有化脓性链球菌的脓疱性病变的比例在MDA后下降。大环内酯类耐药的比例有短暂的增加。临床试验Registrationclinicaltrials.gov（NCT 02775617）。疥疮是脓疱病的主要原因。我们评估了在伊维菌素类药物中添加阿奇霉素对急性腹泻患病率的影响。伊维菌素处理的社区与伊维菌素和阿奇霉素处理的社区之间的脓疱减少没有差异。
Background Scabies is a public health problem in many countries, with impetigo and its complications important consequences. Ivermectin based mass drug administration (MDA) reduces the prevalence of scabies and, to a lesser extent, impetigo. We studied the impact of co-administering azithromycin on the prevalence of impetigo and antimicrobial resistance.Methods Six communities were randomized to receive either ivermectin-based MDA or ivermectin-based MDA co-administered with azithromycin. We measured scabies and impetigo prevalence at baseline and 12 months. We collected impetigo lesions swabs at baseline, 3 and 12 months to detect antimicrobial resistance.Results At baseline, scabies and impetigo prevalences were 11.8% and 10.1% in the ivermectin-only arm and 9.2% and 12.1% in the combined treatment arm. At 12 months, the prevalences had fallen to 1.0% and 2.5% in the ivermectin-only arm and 0.7% and 3.3% in the combined treatment arm. The proportion of impetigo lesions containing Staphylococcus aureus detected did not change (80% at baseline vs 86% at 12 months; no significant difference between arms) but the proportion containing pyogenic streptococci fell significantly (63% vs 23%, P < .01). At 3 months, 53% (8/15) of S. aureus isolates were macrolide-resistant in the combined treatment arm, but no resistant strains (0/13) were detected at 12 months.Conclusions Co-administration of azithromycin with ivermectin led to similar decreases in scabies and impetigo prevalence compared to ivermectin alone. The proportion of impetigo lesions containing pyogenic streptococci declined following MDA. There was a transient increase in the proportion of macrolide-resistant S. aureus strains following azithromycin MDA.Clinical Trials Registrationclinicaltrials.gov (NCT02775617).Scabies is a major cause of impetigo. We assessed the effect on impetigo prevalence of adding azithromycin to ivermectin mass drug. The decrease in impetigo did not differ between communities treated with ivermectin and communities treated with ivermectin and azithromycin.