Comparing the efficacy of one dose oral azithromycin and 1% topical tetracycline ointment in mass treatmant of trachoma in endemic areas

INTRODUCTION & AIM Trachoma which is the serotype of A, B, Ba or C of Chlamydia trahomatis is a chronic and recurrent infection of the eye and can cause reduction in sight. Searching for the prevalence of trachoma in Öncüpinar village of Kilis which is accepted as an endemic area according to the data given by World Health Organization (WHO). We aim to investigate the efficacy of 1% tetracycline (oxytetracycline HCL+polymixin-B) topical ointment twice a day for six weeks comparing with one dose oral azithromycin (20mg/kg, maximum dose 1 gr) in the mass treatment of the people having active trachoma. We also compared the accordance of two drugs within the patient groups, topical and systemic side effects of these two drugs and tolerability of the treatment for the patients through three months following the beginning of treatment. METHODS According to the grading classification of WHO, totally 40 of 135 patients are accepted as active trachomas, TF (Trachoma follicular-18 patients) or TI (Trachoma intense- 22 patients). Twenty four of our active trachoma patients were women (17.7%). Ten women were in TF (7.4%) period, and 14 were in TI (10.3%) period, 16 of the active trachoma patients were men (11.8%). Eight men were in TF (5.92%) period, and 8 were in TI (5.92%) period. The patients were divided into two groups having 20 persons each. First treatment group includes totally 20 patients as 4 patients with TF (2.96%) average age 29 years, 4 patients (2.96%) with TI average age 27.25 years, 8 men (5.92%), VII and 6 patients with TF (4.44%) average age 25.8 years, 6 patients with TI (4.44%) average age 28 years, 12 women (8.88%). Second treatment group includes totally 20 patients as 4 patients with TF (2.96%) average age 28.50 years, 4 patients (2.96%) with TI average age 33. 50 years, 8 men (5.92%), and average age 33.25 years, and 4 patients with TF (4.44%) average age 28.25 years, 8 patients with TI (5.92%) average age 33.25 years, 12 women (8.88%). First group was given synchronously an oral dose of azithromycin (20mg/kg, maximum dose 1gr) as AZ group. The second group was given 1% tetracycline topical ointment twice a day for six weeks as TC group. RESULTS The prevalence of active disease was respectively, 14.81% for group AZ and 14.81% for group TC before the beginning of the treatment. At the third month following the treatment the prevalence of the active disease was 3 patients (2.22%) for group AZ and 3 patients (2.22%) for group TC. there was no statistically significant defference between two treatment groups for adults (p>0.05). CONCLUSION Although there was no significant difference between two treatment groups (AZ, TC) for the success in preventing the progression of complications and reduction of trachoma prevalence, it was shown one dose oral azithromycin (20mg/kg, maximum dose: 1 gr) which is a good alternative to routinely used 1% tetracycline topical ointment, in the treatment of trachoma and preventing the recurrence. Oral azithromycin also revealed less side effects than topical tetracycline application. Beside this feature, oral azithromycine has good clinical response in extraocular infection for the C. Trachomatis, high bioavailibility and half-life circulation in infected tissues as well. On the other hand, 1% tetracycline topical ointment treatment needs everyday twice applications through two weeks and had more side effects like blurring, lacrimation, foreign body feeling and irritation in the eyes.