Thuy Doan1,2, Teshome Gebre3, Berhan Ayele3, Mulat Zerihun3, Armin Hinterwirth1, Lina Zhong1, Cindi Chen1, Kevin Ruder1, Zhaoxia Zhou1, Paul M Emerson4,5, Travis C Porco1,2,6, Jeremy D Keenan1,2, Thomas M Lietman1,2,6,7. 1. Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA. 2. Department of Ophthalmology, University of California San Francisco, CA. 3. The Carter Center Ethiopia, Addis Ababa, Ethiopia. 4. International Trachoma Initiative, Addis Ababa, Ethiopia. 5. International Trachoma Initiative, Atlanta, GA. 6. Department of Epidemiology and Biostatistics, University of California San Francisco, CA; and. 7. Institute for Global Health Sciences, University of California San Francisco, CA.
Abstract
PURPOSE: The aim of this study was to evaluate the effect of the 4 times per year mass azithromycin distributions on the ocular surface microbiome of children in a trachoma endemic area. METHODS: In this cluster-randomized controlled trial, children aged 1 to 10 years in rural communities in the Goncha Seso Enesie district of Ethiopia were randomized to either no treatment or treatment with a single dose of oral azithromycin (height-based dosing to approximate 20 mg/kg) every 3 months for 1 year. Post hoc analysis of ocular surface Chlamydia trachomatis load, microbial community diversity, and macrolide resistance determinants was performed to evaluate differences between treatment arms. RESULTS: One thousand two hundred fifty-five children from 24 communities were included in the study. The mean azithromycin coverage in the treated communities was 80% (95% CI: 73%-86%). The average age was 5 years (95% CI: 4-5). Ocular surface C. trachomatis load was reduced in children treated with the 4 times per year azithromycin ( P = 0.0003). Neisseria gonorrhoeae , Neisseria lactamica , and Neisseria meningitidis were more abundant in the no-treatment arm compared with the treated arm. The macrolide resistance gene ermB was not different between arms ( P = 0.63), but mefA / E was increased ( P = 0.04) in the azithromycin-treated arm. CONCLUSIONS: We found a reduction in the load of C. trachomatis and 3 Neisseria species in communities treated with azithromycin. These benefits came at the cost of selection for macrolide resistance.
PURPOSE: The aim of this study was to evaluate the effect of the 4 times per year mass azithromycin distributions on the ocular surface microbiome of children in a trachoma endemic area. METHODS: In this cluster-randomized controlled trial, children aged 1 to 10 years in rural communities in the Goncha Seso Enesie district of Ethiopia were randomized to either no treatment or treatment with a single dose of oral azithromycin (height-based dosing to approximate 20 mg/kg) every 3 months for 1 year. Post hoc analysis of ocular surface Chlamydia trachomatis load, microbial community diversity, and macrolide resistance determinants was performed to evaluate differences between treatment arms. RESULTS: One thousand two hundred fifty-five children from 24 communities were included in the study. The mean azithromycin coverage in the treated communities was 80% (95% CI: 73%-86%). The average age was 5 years (95% CI: 4-5). Ocular surface C. trachomatis load was reduced in children treated with the 4 times per year azithromycin ( P = 0.0003). Neisseria gonorrhoeae , Neisseria lactamica , and Neisseria meningitidis were more abundant in the no-treatment arm compared with the treated arm. The macrolide resistance gene ermB was not different between arms ( P = 0.63), but mefA / E was increased ( P = 0.04) in the azithromycin-treated arm. CONCLUSIONS: We found a reduction in the load of C. trachomatis and 3 Neisseria species in communities treated with azithromycin. These benefits came at the cost of selection for macrolide resistance.
Authors: K C Chern; S K Shrestha; V Cevallos; H L Dhami; P Tiwari; L Chern; J P Whitcher; T M Lietman Journal: Br J Ophthalmol Date: 1999-12 Impact factor: 4.638
Authors: K Nagai; Y Shibasaki; K Hasegawa; T A Davies; M R Jacobs; K Ubukata; P C Appelbaum Journal: J Antimicrob Chemother Date: 2001-12 Impact factor: 5.790
Authors: Jenafir I House; Berhan Ayele; Travis C Porco; Zhaoxia Zhou; Kevin C Hong; Teshome Gebre; Kathryn J Ray; Jeremy D Keenan; Nicole E Stoller; John P Whitcher; Bruce D Gaynor; Paul M Emerson; Thomas M Lietman Journal: Lancet Date: 2009-03-28 Impact factor: 79.321
Authors: Jeremy D Keenan; Stephanie A Chin; Abdou Amza; Boubacar Kadri; Baido Nassirou; Vicky Cevallos; Sun Y Cotter; Zhaoxia Zhou; Sheila K West; Robin L Bailey; Travis C Porco; Thomas M Lietman Journal: Clin Infect Dis Date: 2018-11-13 Impact factor: 9.079
Authors: Brian M Greenwood; Abraham Aseffa; Dominique A Caugant; Kanny Diallo; Paul A Kristiansen; Martin C J Maiden; James M Stuart; Caroline L Trotter Journal: Trop Med Int Health Date: 2018-12-06 Impact factor: 2.622
Authors: Jeremy D Keenan; Ahmed M Arzika; Ramatou Maliki; Sanoussi Elh Adamou; Fatima Ibrahim; Mariama Kiemago; Nana Fatima Galo; Elodie Lebas; Catherine Cook; Benjamin Vanderschelden; Robin L Bailey; Sheila K West; Travis C Porco; Thomas M Lietman Journal: Lancet Glob Health Date: 2020-02 Impact factor: 26.763
Authors: Kieran S O'Brien; Paul Emerson; P J Hooper; Arthur L Reingold; Elena G Dennis; Jeremy D Keenan; Thomas M Lietman; Catherine E Oldenburg Journal: Lancet Infect Dis Date: 2018-10-03 Impact factor: 25.071
Authors: Thuy Doan; Armin Hinterwirth; Lee Worden; Ahmed M Arzika; Ramatou Maliki; Cindi Chen; Lina Zhong; Zhaoxia Zhou; Nisha R Acharya; Travis C Porco; Jeremy D Keenan; Thomas M Lietman Journal: Ophthalmology Date: 2020-02-20 Impact factor: 12.079