Article Text

PDF
Impact of oral azithromycin on recurrence of trachomatous trichiasis in Nepal over 1 year
  1. H Zhang1,
  2. R P Kandel2,
  3. H K Atakari2,
  4. D Dean1,3
  1. 1Children’s Hospital Oakland Research Institute, Oakland, CA, USA
  2. 2Lumbini Rana-Ambika Eye Hospital, Bhairahawa, Nepal
  3. 3Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
  1. Correspondence to: Dr Deborah Dean University of California School of Medicine, Children’s Hospital Oakland Research Institute, 5700 Martin Luther King Jr Way, Oakland, CA 94609, USA; ddean{at}chori.org

Abstract

Background: Recently, a significant association between Chlamydia trachomatis infection and postoperative trachomatous trichiasis (TT) recurrence was shown. The current study evaluated whether azithromycin treatment at the time of surgery could reduce recurrence.

Methods: As part of Nepal’s national trachoma control programme, patients received azithromycin (53 patients) or placebo (56 patients) at surgery. Conjunctivae were graded for trachoma and swabbed to detect chlamydiae preoperatively and postoperatively up to 12 months. Logistic regression was performed for associations of treatment option with recurrence, infection, and active trachoma (by eye and by patient).

Results: TT recurrence was 28.9% at 12 months. Recurrence was significantly lower for those with major TT at baseline in the azithromycin group at 12 months (p = 0.03); incident recurrence was also significantly lower at 6 months (OR, 0.056; 95% CI, 0 to 0.423; p = 0.004). There was a trend for increased recurrence among those with minor TT at baseline and for reduction of active trachoma and infection in the azithromycin group but not the placebo group.

Conclusion: These data suggest that azithromycin treatment at the time of surgery may be warranted for patients with major TT. However, treatment should be investigated further for minor TT, for efficacy at subsequent time intervals and in other trachoma endemic settings.

  • BTRS, bilamellar tarsal rotation surgery
  • OD, optical density
  • PCR, polymerase chain reaction
  • SES, socioeconomic status
  • TF, follicular trachoma
  • TI, inflammatory trachoma
  • TT, trachomatous trichiasis
  • trachomatous trichiasis
  • trichiasis surgery
  • azithromycin
  • Chlamydia trachomatis
  • trichiasis recurrence
  • BTRS, bilamellar tarsal rotation surgery
  • OD, optical density
  • PCR, polymerase chain reaction
  • SES, socioeconomic status
  • TF, follicular trachoma
  • TI, inflammatory trachoma
  • TT, trachomatous trichiasis
  • trachomatous trichiasis
  • trichiasis surgery
  • azithromycin
  • Chlamydia trachomatis
  • trichiasis recurrence

Statistics from Altmetric.com

Footnotes

  • There are no competing interests.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.