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Blindness And Trachoma

A study in the September 27 issue of JAMA says that using antibiotic azithromycin to treat trachoma in Vietnam had increased the risk of reinfections.// Trachoma is an infectious disease where scar tissue forms underneath the eyelid. In 1995 the WHO reported that 15 percent of all blindness was caused by trachoma. This was the second biggest cause of blindness after cataract.

At that time, the WHO estimated that 146 million individuals were in need of treatment for active trachoma to prevent blindness, 10 million were in need of surgery for trachomatous trichiasis (eyelash[es] touching the eye), and 8 million were already blind, according to background information in the article.

In 1996, the WHO designed the SAFE (Surgery for trachomatous trichiasis; Antibiotics for Chlamydia trachomatis (a type of Chlamydia that causes trachoma); Facial cleanliness; and Environmental improvement) strategy with the goal of elimination of blinding trachoma by the year 2020. For the antibiotic arm of the SAFE strategy, the WHO has recommended antibiotic treatment with either topical tetracycline or oral azithromycin for certain categories of patients with active trachoma. Oral azithromycin has become the drug of choice for the SAFE programs because of difficulties concerning administration and adherence with topical tetracycline eye ointment. Despite a number of studies, there has been a lack of sufficient follow-up beyond the final treatment point to determine rates of recurrence of disease and infection and the risk factors that may contribute to each.

Berna Atik, M.D., M.P.H., of Children's Hospital Oakland Research Institute, Oakland, Calif., and colleagues evaluated the effect of targeted oral azithromycin treatment of school age children and their household members in Vietnam on active trachoma and C trachomatis infection rates. Vietnam is 1 of 16 priority countries in which the SAFE program has been launched. Three communes, which included 3,18
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