An observational assessment of the safety of mass drug administration for trachoma in Ethiopian children

Abstract

Background The International Trachoma Initiative (ITI) provides azithromycin for mass drug administration (MDA) to eliminate trachoma as a public health problem. Azithromycin is given as tablets for adults and powder for oral suspension (POS) is recommended for children aged <7 y, children <120 cm in height (regardless of age) or anyone who reports difficulty in swallowing tablets. An observational assessment of MDA for trachoma was conducted to determine the frequency with which children aged 6 mo through 14 y received the recommended dose and form of azithromycin according to current dosing guidelines and to assess risk factors for choking and adverse swallowing events (ASEs). Methods MDA was observed in three regions of Ethiopia and data were collected on azithromycin administration and ASEs. Results A total of 6477 azithromycin administrations were observed; 97.9% of children received the exact recommended dose. Of children aged 6 mo to <7 y or <120 cm in height, 99.6% received POS. One child experienced choking and 132 (2%) experienced ≥1 ASEs. Factors significantly associated with ASEs included age 6–11 mo or 1–6 y, non-calm demeanor and requiring coaxing prior to drug administration. Conclusions There is a high level of adherence to the revised azithromycin dosing guidelines and low incidence of choking and ASEs.

Perceptions and acceptability of co-administered albendazole, ivermectin and azithromycin mass drug administration, among the health workforce and recipient communities in Ethiopia

“…Some of our respondents described initial concerns about taking up to nine pills at one time. NTD programshave gone to great lengths in recent years to reduce the chance of choking PLOS NEGLECTED TROPICAL DISEASES [14]. Recent studies and policy documents have discussed a variety of possible causes of previous choking episodes, including pressure for compliance from the health work force, social pressure amongst beneficiaries, a lack of patient awareness and a lack of perceived right of refusal [14,15].…”

“…NTD programshave gone to great lengths in recent years to reduce the chance of choking PLOS NEGLECTED TROPICAL DISEASES [14]. Recent studies and policy documents have discussed a variety of possible causes of previous choking episodes, including pressure for compliance from the health work force, social pressure amongst beneficiaries, a lack of patient awareness and a lack of perceived right of refusal [14,15]. We created specific diagrams for the health work force to use during co-administration, encouraging a 'two pills, swallow, pause, two pills.…”

Safety of integrated preventive chemotherapy for neglected tropical diseases

“…The availability of azithromycin as an oral suspension for trachoma elimination and the new rapidly disintegrating, chewable formulation of mebendazole and orally dispersible formulation of praziquantel represent significant advances for MDA safety. Recent data from Ethiopia suggest that risk of choking and other adverse swallowing events is significantly lower among young children who are given azithromycin oral suspension than for children receiving albendazole tablets (whether crushed or not) for STH [ 15 , 65 ]. Therefore, coadministering whole deworming tablets with azithromycin oral suspension may represent a significant increase in choking risk compared to oral suspension alone.…”