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Should mass distribution of azithromycin be in topical rather than oral formulation?
In this issue, Cochereau et al1 present the results of a randomised controlled trial comparing the effectiveness of topical and oral azithromycin for treatment of active trachoma in children (see page 667).
Trachoma remains a leading cause of blindness in the world, responsible for an estimated 1.3 million cases.2 The World Health Organization (WHO) recommends the SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy to control blinding trachoma, which includes the distribution of antibiotics to treat the Chlamydia trachomatis infection that causes active trachoma. Until recently, the treatment of choice was topical administration of 1% tetracycline ointment twice daily for 6 weeks or on 5 consecutive days each month for 6 months. This regimen had low adherence because of the long duration of treatment and the discomfort caused by the ointment. An alternative treatment is a single oral dose of azithromycin. Observational studies suggest that oral azithromycin is highly effective at reducing active trachoma and infection with C trachomatis in the community,3–6 although evidence from randomised controlled trials is inconclusive.7
Azithromycin is costly, but, thanks to Pfizer’s generous donation of the drug, mass distribution has been undertaken …