Azithromycin and Trachoma

Message from Dr S Mariotti, WHO Prevention of Blindness and Deafness Team:

27 January 2003

As an overall statement we would like to support the proposal of MSF to include azithromycin in the WHO Model List of Essential Medicines, as it is a very effective drug in treatment of active trachoma and an effective tool as part of the WHO recommended SAFE strategy (Surgery, Antibiotics, Face-washing and Environmental change).

With regards to the paper, there are some editorial changes or comments I would like to make on the sections pertaining to trachoma treatment: they follow below in order.

Comments on MSF text

PAGE 5, 7.3

Azithromycin is as effective as 6 weeks of tetracycline ointment b.d.

7.3.Trachoma

In 1996, a WHO Expert Committee concluded that Azithromycin 20mg/kg was as effective as 6-7 weeks of topical tetracycline eye ointment, and that it was well tolerated with good patient compliance. …………………

A single oral dose (1g stat or 20mg/kg if <45kg) is as effective as 6-week course of daily tetracycline ointment in clearing ocular chlamydial infection and in resolving the signs of trachoma17.

PAGE 5, 7.3

Updated evidence shows that one dose/year may not be enough for the control of active trachoma in a community, and treatment schemes are still under study to determine which is best at different endemicity levels and in different ethnic groups.

PAGE 7, 8

Azithromycin administration regimen in trachoma elimination efforts is one or two administrations per year (but clear evidence on which administration regime is superior is lacking at present.

7.3.Trachoma

For control of trachoma in entire communities, a short course of oral azithromycin is more effective than the standard 6-weeks course of daily tetracycline ointment. Community-wide treatment with oral Azithromycin markedly reduces C Trachomatis infection and clinical trachoma in endemic areas and may be an important approach to control of trachoma.20

…………………………

Oral Azithromycin therefore appears to offer a means for controlling blinding trachoma. It is easy to administer and higher coverage’s may be possible than have been achieved hitherto.22

PAGE 9, 8

US Food and Drug Administration includes azithromycin in Class B; evidence of teratogenic effect lacking. Current policy is to treat pregnant women with azithromycin or offer no treatment and azithromycin quickly after delivery.

PAGE 13, 10.11

International Trachoma Initiative was founded in 1998 by the Edna McConnell Clark Foundation and Pfizer Inc (no other entity), to

”achieve global elimination of blinding trachoma by putting into action the four components of the (WHO recommended) SAFE strategy, including donated Zithromax, applied research and program evaluation, and communications and advocacy”

Today, the International Trachoma Initiative supports donation projects in some trachoma endemic, including: Morocco, Mali, Ghana, Vietnam, Sudan, Tanzania, Nepal; projects will start in Ethiopia, Egypt and Niger soon.

Reference site

NTERNATIONAL ALLIANCE FOR THE

International alliance for global elimination of blinding trachoma