Failure of Trachoma Treatment with Ophthalmic Antibiotics and Systemic Sulfonamides Used Alone or in Combination with Trachoma Vaccine

The effect of antibiotic treatment on active trachoma and ocular Chlamydia trachomatis infection

“…Six trials compare topical tetracycline with placebo or no treatment [27][28][29][30][31][32]. One of these is excluded because it is not possible to identify patient outcomes: in some instances, both eyes of the same subject were used (separately) in the randomization; the results are reported by eye rather than by subject [31].…”

“…One of these is excluded because it is not possible to identify patient outcomes: in some instances, both eyes of the same subject were used (separately) in the randomization; the results are reported by eye rather than by subject [31]. Of the remaining five trials, four [27,29,30,32] permit evaluation of topical tetracycline against no treatment and one [28] permits evaluation of topical tetracycline against oral placebo.…”

“…Three of five trials demonstrate a statistically significant effect of topical tetracycline against active trachoma at three months [27,30,32]. One suggests that tetracycline is beneficial, but the result is not statistically significant [29].…”

“…One trial finds a nonstatistically significant deleterious effect of tetracycline on the point prevalence of active trachoma at 3 months [28]. Only one [32] of the three trials that continue follow-up to 12 months [28,29,32] associates topical tetracycline with a reduction in point prevalence of active trachoma at that time point. None of the trials shows a statistically significant effect against C. trachomatis infection at either 3 or 12 months.…”

Elimination of trachoma: are we in danger of being blinded by the randomised controlled trial?

“…In all, 10 of the 13 papers that were reviewed only considered the treatment of individuals, not mass community-wide treatment, and thus should have been excluded from analysis as they did not deal with the question asked. [10][11][12][13][14][15][16][17][18][19] Secondly, three of the reviewed studies assessed antibiotics that are no longer used in trachoma-control programmes. 11 13 15 Thirdly, the strict inclusion criteria used by the Cochrane Database limited the review to RCTs and meant that good evidence from cohort studies, such as those mentioned above, was not considered.…”