3-monthly azithromycin administration for trachoma
Faculty of Medicine and Health Sciences
The lancet : international edition. - London, 1823, currens
, p. 449-
University of Antwerp
Jenafir House and colleagues (March 28, p 1111)1 elegantly demonstrate the herd protection effect of antimicrobials by treating African children aged 110 years for trachoma. Children who were treated with a quarterly single dose of azithromycin had a significantly lower disease prevalence than did children who, as part of WHO-recommended mass prophylaxis, received a yearly dose. Individuals older than 10 years who did not receive antibiotics also had a two-fold lower infection prevalence than at baseline; however, this reduction was no different from that seen in the population receiving WHO-recommended prophylaxis. This finding is important because adults have more severe disease than children. Children are also the main reservoirs of Streptococcus pneumoniae,2 and, in resource-poor regions where pneumococcal disease often proves lethal in young children, the development of antimicrobial resistance could further reduce the chances of children receiving antibiotics effective against such infections. Azithromycin use has been associated with the emergence of resistance to macrolide antibiotics3 and with the selection of strains multiresistant to â-lactams and cephalosporins.4 These drugs are the mainstay of treatment for severe pneumococcal disease, particularly meningitis. Furthermore, we have shown that administration of azithromycin increases drug resistance in oropharyngeal streptococci and that these changes persist for at least 6 months after treatment.5 Once-a-year mass azithromycin dosing, on the other hand, would potentially allow resistance in commensal streptococci to revert to baseline levels. Since most parts of Africa still await introduction of the pneumococcal vaccine, we urge that facial cleanliness and environmental changes to control trachoma are not forsaken. SMK and SC are funded by Research Foundation Flanders (FWO-V), Belgium. We declare that we have no conflicts of interest.