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Global Ophthalmology
Original research
Effectiveness and safety of azithromycin 1.5% eye drops for mass treatment of active trachoma in a highly endemic district in Cameroon
  1. Assumpta Lucienne Bella1,
  2. Ellen Einterz2,
  3. Pierre Huguet3,
  4. Philippe Bensaid4,
  5. Abdou Amza5,
  6. Didier Renault6,7
  1. 1Health Ministry, National Programme for Blindness Control/MoPH, Yaoundé, Cameroon
  2. 2Department of Ophthalmology, Kolofata District Hospital, Kolofata, Cameroon
  3. 3Organisation pour la Prévention de la Cécité, Paris, France
  4. 4Ophthalmo Sans Frontières, Luçon, France
  5. 5Faculté des Sciences de la Santé, Abdou Moumouni University, Niamey, Niger
  6. 6Thea Open Innovation, Laboratoires Théa, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
  7. 7Fondation Théa, Clermont-Ferrand, France
  1. Correspondence to Dr Didier Renault; didier.renault{at}theaopeninnovation.com

Abstract

Objective To evaluate the effectiveness and safety of azithromycin 1.5% eye drops under field conditions to reduce active trachoma in a highly endemic district in Cameroon. This is a follow-up of an initial report published in 2010.

Methods and analysis Three annual campaigns were performed in 2008, 2009 and 2010 to treat the population (~1 20 000 individuals) of the Kolofata Health District with topical azithromycin 1.5% (one drop in each eye, morning and evening for three consecutive days). The effectiveness of this intervention against active trachoma was assessed in children aged 1–9 years in cross-sectional studies prior to each mass treatment using a systematic sampling procedure (in 2008, 2009 and 2010) and then 1 year (2011) and 3 years (2013) after the last intervention among the villages with previously high active trachoma prevalence or never tested.

Results The prevalence of trachomatous inflammation—follicular (TF) dropped from 24.0% (95% CI 20.7 to 27.5) before treatment to 2.8% (95% CI 2.2 to 3.7) 1 year after completion of the 3 year campaign. Trachomatous inflammation—intense was present in only 4 (0.2%) children 1 year after the third round of treatment. Three years after the last campaign, the surveillance survey among the most prevalent villages and villages never tested before showed a prevalence of 5.2% (95% CI 3.6 to 7.2) of active trachoma. Tolerance was excellent, with no report of treatment interruption, serious ocular or systemic adverse events.

Conclusion Annual mass treatment with azithromycin eye drops was shown to be effective in reducing TF to a level ≤5% one year after a 3-round annual mass treatment in an endemic region at the district level.

  • infection
  • public health
  • conjunctiva
  • epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjophth-2020-000531

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    Footnotes

    • Contributors AA was the local responsible ophthalmologist in charge of treatment administration and trachoma evaluation; ALB was the study coordinator; EE contributed to the planning and execution of the study; PH was responsible for statistical methodology and for reporting of study results; DR coordinated the medical writing activities; AA, ALB, PB, EE, PH and DR reviewed and approved the final manuscript.

    • Funding The prevalence surveys were financed by the NGO Ophthalmo Sans Frontières. Laboratoires Théa donated the azithromycin 1.5% eye drops and funded medical writing activities.

    • Competing interests PH was previously employed at Laboratoires Thea and DR is currently employed at Thea Open Innovation and at Fondation Thea.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study was conducted in compliance with the ethical principles of the Declaration of Helsinki regarding biomedical research on human subjects. The study treatment plan received authorisation from the Cameroon Ministry of Public Health in February 2008. The National Ethics Committee of Yaoundé approved the study (Approval 098/CNE/DNM/07 and 086/CNE/DNM/08) and the method of obtaining informed consent. Informed consent was systematically requested from parents of minors. For people who were illiterate, the information sheet and informed consent were read to them. If they agreed to participate, the participant or a legally acceptable representative signed by fingerprint and a literate witness signed on behalf of the participant. Participants or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.