Family-based suppressive intermittent therapy of hyperendemic trachoma with topical oxytetracycline or oral doxycycline.

Abstract

A controlled double-blind stratified trial was carried out in a village in Southern Iran to assess the efficacy of family-based intermittent therapy of hyperendemic trachoma with topical oxytetracycline oily suspension twice daily for 7 days each month, or oral doxycycline 5 mg per kilogram of body weight once a month, in comparison with a control group which received vitamin pills once a month. In addition all other members of the selected children's families were also treated with the same regimen of therapy. The treatment was given for a period of 1 year by 3 field technicians, each responsible for one regimen of therapy. Examining the whole conjunctiva 4 months after the start of therapy, we observed no marked difference in the cure rate or the number of patients with moderate to severe trachoma between the groups treated with antibiotics and the control group. When treatment was continued for 12 months, a marked decrease in the prevalence of trachoma and in the grades of intensity of inflammatory responses as well as the positivity rate for Chlamydia trachomatis was observed in the groups treated with the topical oxytetracycline or oral doxycycline compared with the control group. While there was no marked difference between the efficacy of these 2 regimens of mass chemotherapy, the monthly intermittent therapy with a single dose of doxycycline offers the advantage of being more practical and less expensive for mass control of trachoma by requiring approximately one-tenth of the staff, transport, and other facilities required for the intermittent topical therapy with tetracycline eye ointment.

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

“…Two trials permit evaluation of oral doxycycline against oral placebo [28,33]. One shows a statistically significant effect against active disease at 3 months; follow-up in this trial does not extend to 12 months after the commencement of the intervention [33].…”

“…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.…”

“…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.…”

“…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].…”

Community-based intervention programs for trachoma control

“…With single cycles of topical treatment, subjects in endemic areas show a short-term treatment effect but essentially revert back to pretreatment prevalences after several months [4,5,7]. Long-term suppression of inflammation, or cure rates, or decreased positivity rates for chlamydia, were observed only with family-based treatment extending for at least a year [3] or with community-based mass treatment [19]. The cost associated with a prolonged drug treatment program, including not only the medication itself but also the drug delivery system, is likely to be substantial [6].…”