Azithromycin Reduction to Reach Elimination of Trachoma

减少阿奇霉素以消除沙眼

• 批准号: 10907941
• 负责人: THOMAS M LIETMAN
• 金额: $ 2.6万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10907941
• 关键词: Age; Antibiotics; Area; Azithromycin; Blindness; Child; Chlamydia; Chlamydia Infections; Chlamydia trachomatis; Clinical; Communities; Confidence Intervals; Country; Data; Decision Making; Diagnostic tests; Drops; Early treatment; Europe; Funding; Gambia; Ghana; Goals; Guidelines; Hygiene; Individual; Infection; Inflammation; Intervention; Laos; Low Prevalence; Macrolide-resistance; Measures; Mexico; Nepal; Niger; Prevalence; Public Health; Randomized; Randomized, Controlled Trials; Recommendation; Recrudescences; Residual state; Resources; Sanitation; Savings; Seroprevalences; Surveys; Testing; Trachoma; Uganda; Uveitis; Water; World Health Organization; discontinuation trial; isoniazid; markov model; population based; programs; randomized placebo controlled trial; response; serological marker; tool; transmission process; treatment response

PROJECT SUMMARY/ABSTRACT Annual mass azithromycin distribution dramatically reduces the prevalence of the ocular strains of Chlamydia trachomatis that lead to blinding trachoma. Current World Health Organization guidelines indicate that annual mass azithromycin distribution should be continued until district-level prevalence of the clinical sign of trachoma, trachomatous inflammation-follicular (TF), drops below 5%. However, TF does not correlate well with infection after multiple rounds of azithromycin treatment. Specifically, any decrease in TF lags well behind the decrease in infection. Thus the TF threshold may lead to overuse of antibiotics and depletion of scarce resources. Here, we propose a community randomized controlled trial and diagnostic test study to evaluate whether 1) azithromycin distribution can be discontinued in communities with TF prevalence up to 20%, and 2) alternative indicators of trachoma transmission can better measure true infection. We anticipate that results will provide evidence to support discontinuation of azithromycin treatment earlier, and evidence of that true local elimination of infection can be achieved, altering the goal of the trachoma program from control to eradication.

项目概要/摘要 每年大量阿奇霉素的分发大大降低了眼部衣原体菌株的流行率 导致致盲沙眼的沙眼衣原体。目前世界卫生组织的指导方针表明，每年 应继续大规模分发阿奇霉素，直至该临床症状在地区一级流行为止 沙眼，沙眼滤泡性炎症 (TF)，下降到 5% 以下。然而，TF 相关性并不好 多轮阿奇霉素治疗后出现感染。具体来说，TF 的任何下降都远远落后于 感染减少。因此，TF阈值可能导致抗生素的过度使用和稀缺药物的耗尽。 资源。在这里，我们提出一项社区随机对照试验和诊断测试研究来评估 是否 1) 在 TF 患病率高达 20% 的社区中可以停止阿奇霉素的分发，以及 2) 沙眼传播的替代指标可以更好地衡量真正的感染情况。我们预计结果将 提供证据支持尽早停止阿奇霉素治疗，以及真正的局部证据 可以实现消除感染，从而将沙眼计划的目标从控制转变为根除。

项目成果

Azithromycin Reduction to Reach Elimination of Trachoma (ARRET): study protocol for a cluster randomized trial of stopping mass azithromycin distribution for trachoma.

• DOI: 10.1186/s12886-020-01776-4
• 发表时间: 2021-01-06
• 期刊: BMC ophthalmology
• 影响因子: 2
• 作者: Amza A;Kadri B;Nassirou B;Arzika AM;Austin A;Nyatigo F;Lebas E;Arnold BF;Lietman TM;Oldenburg CE
• 通讯作者: Oldenburg CE