Effectiveness of azithromycin mass drug administration on trachoma: a systematic review

Abstract

Backgrounds: Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. Results: A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. Conclusions: Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.

Stakeholder’s perception on the slow progress towards trachoma elimination and suggested recommendations for future intervention: An interpretive qualitative study in Bugna District, Northeast Ethiopia

“…A study from West Africa and in Ethiopia, Amhara region, con rmed that a double dose of Azithromycin was effective in controlling and eliminating trachoma (38,39), but in Bugna, District, some individuals did not get a single dose of Azithromycin in a year despite the high prevalence of trachoma almost in all kebelles (7). Although, evidence recommended a single dose of Azithromycin to controls TF below 5% effectively (42), a review by Xiong et al disputed that Azithromycin administration to control trachoma should depends on the baseline prevalence (43). The Xiong et al's.…”

“…review concluded that the recommendation by the World Health Organization; an annual MDA for 3 to 5 years in the districts with TF baseline > 10.0% is not appropriate for all districts (43). However, the interview and FGD participants explained that lack of water was the major substantial reason for trachoma persistency in the Bugna District, though they also mentioned that other FE components of SAFE were not addressed well.…”

The impact of mass drug administration of antibiotics on the gut microbiota of target populations

“…Recent interest in MDA with antibiotics has also gained traction due to concerns about emergence of more difficult to treat enteric [ 49 ] and non-enteric [ 49 , 50 ] infections and potential transmission of resistant pathogens to more vulnerable populations [ 49 , 51 ]. The need to balance these risks with the demonstrated benefits of MDA with antibiotics [ 52 , 53 ] is of particular relevance.…”

Hoist the sails, promote the hopes

“…This issue contains a systematic review of the preventive and therapeutic effects of azithromycin mass drug administration on trachoma in different districts and explores the possible methods to enhance the effectiveness of azithromycin mass drug administration in hyperendemic districts. [ 6 ]…”

“…This issue contains a systematic review of the preventive and therapeutic effects of azithromycin mass drug administration on trachoma in different districts and explores the possible methods to enhance the effectiveness of azithromycin mass drug administration in hyperendemic districts. [6] The safety and efficacy of salmeterol/fluticasone versus montelukast, or combination of montelukast and fluticasone in children and adolescents aged 4 to 18 years with bronchial asthma, [7] which is increasing in incidence, was systematically reviewed and evidence was provided for pediatricians to determine their clinical strategy.…”