Antibiotics for trachoma

Abstract

Analysis 1.1. Comparison 1 Any antibiotic versus control (individuals), Outcome 1 Active trachoma at 3 months. . Analysis 1.2. Comparison 1 Any antibiotic versus control (individuals), Outcome 2 Active trachoma at 12 months. . Analysis 1.3. Comparison 1 Any antibiotic versus control (individuals), Outcome 3 Active trachoma at 3 months (subgroup

Antimicrobial stewardship in rural and remote primary health care: a narrative review

“…Risks for AMR development are not limited to the specific antimicrobial agent used to treat a particular infection, as suggested in a recent revision of a Cochrane systematic review on the mass treatment of trachoma using antibiotics [ 32 ]. Here, evidence shows with high certainty that S. pneumoniae , S. aureus and Escherichia coli exhibited approximately fivefold increase in resistance at 12 months not only to agents used to treat trachoma, namely azithromycin and tetracycline, but also to clindamycin despite having no role in trachoma management [ 32 ]. Likewise, Doan et al [ 25 ] found that beta-lactam resistance determinants were 2.1 times (95% CI 1.2–4.0) higher after mass azithromycin distribution.…”

Antimicrobial stewardship in rural and remote primary health care: a narrative review

“…Risks for AMR development are not limited to the specific antimicrobial agent used to treat a particular infection, as suggested in a recent revision of a Cochrane systematic review on the mass treatment of trachoma using antibiotics [ 32 ]. Here, evidence shows with high certainty that S. pneumoniae , S. aureus and Escherichia coli exhibited approximately fivefold increase in resistance at 12 months not only to agents used to treat trachoma, namely azithromycin and tetracycline, but also to clindamycin despite having no role in trachoma management [ 32 ]. Likewise, Doan et al [ 25 ] found that beta-lactam resistance determinants were 2.1 times (95% CI 1.2–4.0) higher after mass azithromycin distribution.…”

Uses of mathematical modeling to estimate the impact of mass drug administration of antibiotics on antimicrobial resistance within and between communities

“…Competition also occurs between hosts: susceptibility and resistance both spill over between populations, with important implications for MDA [ 26 ]. For example, rates of macrolide resistance among S. pneumoniae and E. coli carried by recipients of MDA-azithromycin increase substantially after treatment [ 1 , 27 , 28 ] but then appear to wane in the succeeding months [ 29 , 30 ]. Although this waning could be partly due to intra-individual effects, population-level effects likely play an important role: susceptible strains in untreated individuals can be transmitted to antibiotic-treated individuals [ 19 , 31 ].…”

“…Finally, a statistical model can only be built for antibiotics and pathogens for which there are pre-existing data. While the effects of azithromycin use on macrolide resistance among S. pneumoniae and E. coli are fairly well studied [ 1 , 18 , 27 , 28 ], the effect of azithromycin use on resistance in other pathogens is poorly documented [ 44 ]. Comparing use-resistance associations across pathogens and antibiotics [ 21 , 23 , 45 ] may help fill in some gaps, but this approach is now only speculative.…”

Gender differences in trachomatous scarring prevalence in a formerly trachoma hyperendemic district in Tanzania

“…Individuals living in these communities have had more intense TF transmission in the past leading to early onset of scarring and early progression of scarring. This assumes this current high TF rate is also indicative of prior high TF rates, an assumption which is reasonable given the way TF declines with MDA [21,22]. Research has shown that scarring can progress even after low Ct infection and active trachoma levels, likely due to ongoing inflammatory processes [2,[4][5][6]18,23,24] so at this point we do not expect that the trachoma rates are driving progression, but are rather indicative of past high exposure.…”

Antimicrobial stewardship in rural and remote primary health care: a narrative review

“…Risks for AMR development are not limited to the specific antimicrobial agent used to treat a particular infection, as suggested in a recent revision of a Cochrane systematic review on the mass treatment of trachoma using antibiotics [ 32 ]. Here, evidence shows with high certainty that S. pneumoniae , S. aureus and Escherichia coli exhibited approximately fivefold increase in resistance at 12 months not only to agents used to treat trachoma, namely azithromycin and tetracycline, but also to clindamycin despite having no role in trachoma management [ 32 ]. Likewise, Doan et al [ 25 ] found that beta-lactam resistance determinants were 2.1 times (95% CI 1.2–4.0) higher after mass azithromycin distribution.…”

Uses of mathematical modeling to estimate the impact of mass drug administration of antibiotics on antimicrobial resistance within and between communities

“…Competition also occurs between hosts: susceptibility and resistance both spill over between populations, with important implications for MDA [ 26 ]. For example, rates of macrolide resistance among S. pneumoniae and E. coli carried by recipients of MDA-azithromycin increase substantially after treatment [ 1 , 27 , 28 ] but then appear to wane in the succeeding months [ 29 , 30 ]. Although this waning could be partly due to intra-individual effects, population-level effects likely play an important role: susceptible strains in untreated individuals can be transmitted to antibiotic-treated individuals [ 19 , 31 ].…”

“…Finally, a statistical model can only be built for antibiotics and pathogens for which there are pre-existing data. While the effects of azithromycin use on macrolide resistance among S. pneumoniae and E. coli are fairly well studied [ 1 , 18 , 27 , 28 ], the effect of azithromycin use on resistance in other pathogens is poorly documented [ 44 ]. Comparing use-resistance associations across pathogens and antibiotics [ 21 , 23 , 45 ] may help fill in some gaps, but this approach is now only speculative.…”

Gender differences in trachomatous scarring prevalence in a formerly trachoma hyperendemic district in Tanzania

“…Individuals living in these communities have had more intense TF transmission in the past leading to early onset of scarring and early progression of scarring. This assumes this current high TF rate is also indicative of prior high TF rates, an assumption which is reasonable given the way TF declines with MDA [21,22]. Research has shown that scarring can progress even after low Ct infection and active trachoma levels, likely due to ongoing inflammatory processes [2,[4][5][6]18,23,24] so at this point we do not expect that the trachoma rates are driving progression, but are rather indicative of past high exposure.…”

Antimicrobial stewardship in rural and remote primary health care: a narrative review

“…Risks for AMR development are not limited to the specific antimicrobial agent used to treat a particular infection, as suggested in a recent revision of a Cochrane systematic review on the mass treatment of trachoma using antibiotics [ 32 ]. Here, evidence shows with high certainty that S. pneumoniae , S. aureus and Escherichia coli exhibited approximately fivefold increase in resistance at 12 months not only to agents used to treat trachoma, namely azithromycin and tetracycline, but also to clindamycin despite having no role in trachoma management [ 32 ]. Likewise, Doan et al [ 25 ] found that beta-lactam resistance determinants were 2.1 times (95% CI 1.2–4.0) higher after mass azithromycin distribution.…”

Uses of mathematical modeling to estimate the impact of mass drug administration of antibiotics on antimicrobial resistance within and between communities

“…Competition also occurs between hosts: susceptibility and resistance both spill over between populations, with important implications for MDA [ 26 ]. For example, rates of macrolide resistance among S. pneumoniae and E. coli carried by recipients of MDA-azithromycin increase substantially after treatment [ 1 , 27 , 28 ] but then appear to wane in the succeeding months [ 29 , 30 ]. Although this waning could be partly due to intra-individual effects, population-level effects likely play an important role: susceptible strains in untreated individuals can be transmitted to antibiotic-treated individuals [ 19 , 31 ].…”

“…Finally, a statistical model can only be built for antibiotics and pathogens for which there are pre-existing data. While the effects of azithromycin use on macrolide resistance among S. pneumoniae and E. coli are fairly well studied [ 1 , 18 , 27 , 28 ], the effect of azithromycin use on resistance in other pathogens is poorly documented [ 44 ]. Comparing use-resistance associations across pathogens and antibiotics [ 21 , 23 , 45 ] may help fill in some gaps, but this approach is now only speculative.…”

Gender differences in trachomatous scarring prevalence in a formerly trachoma hyperendemic district in Tanzania

“…Individuals living in these communities have had more intense TF transmission in the past leading to early onset of scarring and early progression of scarring. This assumes this current high TF rate is also indicative of prior high TF rates, an assumption which is reasonable given the way TF declines with MDA [21,22]. Research has shown that scarring can progress even after low Ct infection and active trachoma levels, likely due to ongoing inflammatory processes [2,[4][5][6]18,23,24] so at this point we do not expect that the trachoma rates are driving progression, but are rather indicative of past high exposure.…”