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  • Title: Topical tetracycline and rifampicin therapy of endemic trachoma in Tunisia.
    Author: Dawson CR, Hoshiwara I, Daghfous T, Messadi M, Vastine DW, Schachter J.
    Journal: Am J Ophthalmol; 1975 May; 79(5):803-11. PubMed ID: 1096630.
    Abstract:
    A controlled chemotherapy trial of trachoma was carried out in a Tunisian oasis among schoolchildren with active disease. We compared 1% tetracycline ointment (79 patients) or 1% rifampicin ointment (76 patients) with 5% boric acid ointment (79 patients). Medications were administered twice daily, six days a week, for ten weeks. Slit-lamp examinations by three ophthalmologists were made independently before treatment as well as five, 19, and 39 weeks after treatment. Bacteriologic cultures were taken during treatment as were smears to detect trachoma agent at each clinical examination. Five weeks after treatment, the intensity of conjunctival disease in the tetracycline and rifampicin groups was reduced significantly when compared with boric acid, but at 19 weeks this suppression was found only in the tetracycline group. Ocular bacterial pathogens were eliminated almost entirely in the two antibiotic groups during treatment. The initial prevalence of trachoma (29to 31%) was significantly reduced in the two antibiotic-treated groups at five weeks and 19 weeks after treatment. The prevalence of trachoma was equally low (7%) in all three groups following retreatment with tetracycline. Although both antibiotics were effective, rifampicin offered no advantage over tetracycline in this trial. Recurrent disease in this school-based treatment study probably was due to reinfection from younger siblings at home. While systematic, community-wide, antibiotic treatment programs are not always possible in countries where trachoma is endemic, limited antibiotic therapy programs should be continued in these areas to reduce the intensity and prevalence of trachoma, even though the disease cannot be eradicated. In this study, the authors compared topically applied tetracycline or rifampicin ointment with boric acid ointment administered for 10 weeks for its effect on endemic trachoma. 234 children with active disease were included in the treatment study. Those with the active disease were divided into 2 groups containing equal numbers each of the 3 intensity categories. Then each group was assigned to 1 of 3 treatment categories. Medication was administered twice daily over a single 3-hour class period and a 70-day course of follow-up therapy with 1% tetracycline was provided once daily for all the children 25 weeks after completion of the initial treatment. 62 (26.5%) had severe trachoma and 133 (56.8%) had trachoma of moderate intensity. In March 1972, 5 weeks after treatment completion, the trachoma in the 2 groups treated with antibiotics was less severe compared with the boric acid group. However, by June 1972, only the tetracycline group had less active trachoma than the boric acid treated group. By this time, also, the 3 groups were equally improved. Following the 2nd course of tetracycline treatment 25-35 weeks after the initial trial, there were no differences in any of the groups. 2 courses of therapy, therefore, were no more advantageous than 1. In Giemsa-stained smears prior to treatment, the prevalence of positive smears for Chlamydia agent were similar in the 3 groups; following treatment, prevalence had dropped to 7% overall and then after retreatment, there were rarely any cases in any of the treated groups. While the 2 antibodies were significantly better than boric acid, rifampicin did not seem to offer any significant advantages over tetracycline. The prevalence of trachoma agent appeared to change more readily than the clinical disease. Clearly the pattern of disease intensity and microbial infection displayed a seasonal cycle thatmust be considered when evaluating antibiotic treatment efficacy. The prevalence of trachoma decreases with age and that, along with the seasonality, contribute to the disease intensity. In this study, treatment did alter the disease temporarily but did not affect its course in the long run since environmental factors which originally produced the disease had not changed. Only communitywide chemotherapy would have a significant effect. However, antibiotic treatment is necessary to reduce the occurrence of later complications.
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