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Skip to 0 minutes and 13 secondsHello and welcome to week 3. This week, we discuss antibiotics and, specifically, azithromycin, as the 'A' component of the SAFE strategy. Azithromycin is given to the whole, eligible population of trachoma endemic communities in order to treat chlamydia infection and to reduce its transmission. The strategy for antibiotic distribution is called Mass Drug Administration or MDA. MDA is also used to treat several other infectious diseases, including onchocerciasis and lymphatic filariasis. Azithromycin, whose trade name is Zithromax, is donated by Pfizer for trachoma elimination as part of the SAFE strategy. International NGOs partner with ministries of health to obtain the antibiotics and support the logistics of MDA.

Skip to 1 minute and 15 secondsThis week we will discuss which communities require azithromycin, who is eligible to receive it, and the frequency and duration of treatment, and how to achieve a high MDA coverage while ensuring accountability and safety of the medicine. I hope you enjoy this week.

Welcome to week 3: A is for antibiotics

Antibiotics are used to reduce the force of transmission of ocular Chlamydia trachomatis in endemic communities. Some of the questions that you might have about antibiotic treatment include:

  • Which antibiotics are recommended?
  • What dose is required to provide effective treatment?
  • Can it be a single dose or do we have to carry out repeated treatments?
  • What level of coverage is needed?
  • Once antibiotic treatment is stopped, what is the likelihood of trachoma coming back?

For many years, topical tetracycline ointment was the main antibiotic used to treat trachoma. However, tetracycline requires prolonged courses: six weeks of twice-daily application into both eyes, and it stings the eyes slightly when it goes in. Following many years of rigorous research, azithromycin is now preferred as the antibiotic of choice for trachoma. Pfizer donates huge quantities of branded oral azithromycin (Zithromax) to trachoma elimination programmes all over the world, through the International Trachoma Initiative.

Azithromycin is given as a safe (non-toxic) single oral dose. It is ideal for mass distribution as there is no need for individual diagnosis, and treatment can be given by primary health workers and volunteers. In addition, azithromycin is a broad spectrum antibiotic and treats respiratory, skin and genital infections at the same time, so is generally very well accepted by communities.

In a trachoma-endemic area, repeated mass treatment is usually needed to achieve programme targets. It must also be accompanied by the F and E components of the SAFE strategy to sustainably eliminate trachoma.

This week, we look closely at who and how to treat, how to coordinate and manage mass distribution and, importantly, knowing when to stop.

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Eliminating Trachoma

London School of Hygiene & Tropical Medicine

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