Efficacy of oral azithromycin versus topical tetracycline in mass treatment of endemic trachoma

objective: to compare the impact of mass treatment with oral azithromycin and topical tetracycline on the prevalence of active trachoma. methods: a total of 1803 inhabitants from 106 households of eight gambian villages were randomized, in pairs, to receive either three doses of azithromycin at weekly intervals, or daily topical tetracycline over 6 weeks. ocular examinations were conducted before treatment, and 2, 6 and 12 months after treatment. findings: prior to treatment, 16% of the study participants had active trachoma. two months after treatment, the prevalence of trachoma was 4.6% and 5.1% in the azithromycin and the tetracycline groups, respectively (adjusted odds ratio (or) = 1.09; 95% confidence interval (ci) = 0.53, 2.02). subsequently, the prevalence rose to 16% in the tetracycline group, while remaining at 7.7% in the azithromycin group (adjusted or at 12 months = 0.52; 95% ci = 0.34, 0.80). at 12 months post-treatment, there were fewer new prevalent cases in the azithromycin group, and trachoma resolution was significantly better for this group (adjusted or = 2.02; 95% ci = 1.42, 3.50). conclusion: oral azithromycin therefore appears to offer a means for controlling blinding trachoma. it is easy to administer and higher coverages may be possible than have been achieved hitherto.