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Richard J. C. Bowman, Ansumana Sillah, Carlijn van Dehn, Victoria M. Goode, Mahiul Muquit, Gordon J. Johnson, Paul Milligan, Jane Rowley, Hannah Faal, Robin L. Bailey; Operational Comparison of Single-Dose Azithromycin and Topical Tetracycline for Trachoma. Invest. Ophthalmol. Vis. Sci. 2000;41(13):4074-4079.
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purpose. World Health Organization guidelines for antibiotic treatment of
trachoma currently include a 6-week course of tetracycline eye ointment
twice daily or a single dose of oral azithromycin. Previous trials have
shown similar efficacy of these two alternatives when administration of
the ointment was carefully supervised. It is believed, however, that
azithromycin may be a more effective treatment in practice, and the
purpose of this study was to test that hypothesis.
methods. A masked randomized controlled trial was conducted to compare
azithromycin and tetracycline under practical operational
conditions—i.e., without supervision of the administration of the
ointment. Three hundred fourteen children aged 6 months to 10 years
with clinically active trachoma were recruited and individually
randomized to receive one of the two treatments. Follow-up visits were
conducted at 10 weeks and 6 months. The outcome was resolution of
disease (clinical “cure”).
results. Children allocated to azithromycin were significantly more likely to
have resolved disease than those allocated to tetracycline, both at 10
weeks (68% versus 51%; cure rate ratio, 1.31; 95% confidence
interval [CI], 1.08–1.59; P = 0.007) and at 6
months (88% versus 73%; cure rate ratio, 1.19; 95% CI, 1.06–1.34; P = 0.004). Azithromycin was particularly effective
for intense inflammation (P = 0.023, Fisher’s
conclusions. Single-dose oral azithromycin was a more effective treatment for active
trachoma than tetracycline ointment as applied by caregivers. The high
cure rate achieved with tetracycline in this study in the absence of
supervision and the significantly higher costs of azithromycin, suggest
that in the absence of donation programs, switching routine treatment
from tetracycline to azithromycin would not be a good use of
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