August 23, 2022 Stewardship/Resistance Analysis

Trial finds no impact on trachoma of massive azithromycin distribution

A randomized clinical trial in Niger found that mass distribution of azithromycin to preschool children was no more effective in reducing the incidence of trachoma than placebo, researchers reported today. JAMA network open.

The cluster-randomised trial, conducted by researchers from the Oral Macrolides to Reduce Deaths with an Eye on Resistance (MORDOR)-Niger study group, assessed the effects of six-monthly mass distribution of azithromycin to children aged from 1 to 59 months in 30 villages in a region of Niger considered to have hypoendemic trachoma. The World Health Organization (WHO) recommends mass distribution of azithromycin in districts affected by trachoma, the leading infectious cause of blindness worldwide, but fear that mass administration of antibiotics to entire communities promotes antibiotic resistance has led researchers to wonder if targeted distribution might be a better solution. strategy.

A total of 4756 children in 30 communities were included, with 1695 children enrolled in 15 azithromycin communities and 3031 in 15 placebo communities. Enrolled children received a single dose of oral azithromycin or oral placebo every 6 months for 24 months. The primary outcome of the trial was the incidence of trachomatous inflammation follicular (TF).

The mean prevalence of TF at baseline was 1.9% (95% confidence interval [CI], 0.5% to 3.5%) in the azithromycin group and 0.9% (95% CI, 0 to 1.9%) in the placebo group. At 24 months, the prevalence of TF was 0.2% (95% CI, 0 to 0.5%) in the azithromycin group and 0.8% (95% CI, 0.2% to 1, 6%) in the placebo group. The lower incidence of TF in the azithromycin group was not considered statistically significant (baseline-adjusted incidence rate ratio: 0.18 [95% CI, 0.01 to 1.20]).

The study authors say the low baseline prevalence of trachoma in communities makes it difficult to determine whether targeted mass distribution of azithromycin to preschool children could be an effective strategy for trachoma elimination. It also suggests that trachoma may have been eliminated as a public health problem in these communities.

“It remains unclear whether azithromycin distributions to preschoolers would be effective in other areas with hypoendemic trachoma that have slightly more infection than those assessed in the present study,” they wrote. .
August 23 JAMA Netw Open study

Treatment of multidrug-resistant tuberculosis more effective than expected

A systematic review and meta-analysis of studies from West and Central African countries found higher than expected treatment success rates for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB), reported yesterday researchers in the International Journal of Infectious Diseases.

Analysis of 14 studies from 14 countries in the two regions, published from 2005 to 2020 and involving 4,268 people, found that the overall treatment success was 74.6% (95% confidence interval [CI], 65% to 82.2%), with a combined success rate of 80.8% (95% CI, 56% to 93.3%) for the Central African subgroup and 69.3% for the – West African group (95% CI, 56.3% to 79.7%). The estimated proportion of MDR/RR TB patients successfully treated was significantly higher than the WHO estimate of 59% and met the 2015 WHO target of 75% MDR TB treatment success .

The results are surprising because the studies were conducted while countries in the region were using the standard treatment regimen for multidrug-resistant tuberculosis, which lasts 18 to 24 months and includes injectable drugs. Poor adherence to this regimen has been associated with low treatment success rates. The authors note that the results may be explained by the early introduction of a 9- to 11-month regimen in many of the included countries, as well as the lack of data from 12 countries in the region.

“Whether this reflects the true treatment success rate or if the rate is skewed due to underreporting remains unknown,” they wrote.

In 2022, the WHO approved a 6-month all-oral regimen for multidrug-resistant tuberculosis that experts hope will lead to even better treatment outcomes.
August 22 Int J Infect Dis study

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