单次使用阿奇霉素预防术后倒睫复发:埃塞俄比亚的随机试验

Single-dose azithromycin prevents trichiasis recurrence following surgery:Randomized trial in Ethiopia

Background:Trichiasis recurrence following surgery is a serious problem for trachoma programs.Objective:To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year,and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient.Design:A randomized,single-masked,clinical trial was conducted in Ethiopia.A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms:single-dose(1 g)oral azithromycin alone,single-dose azithromycin for household members(20 mg/kg up to 1 g)plus the patient,or topical tetracycline(twice per day for 6 weeks).Main Outcome Measures:Trichiasis recurrence within 1 year following surgery.Results:The combined azithromycin groups had significantly fewer recurrences,6.9 of 100 person-years overall,compared with topical tetracycline,10.3 of 100 personyears(P=.047).There was no additional reduction in the arm that also treated household members,8.1 of 100 person-years,compared with treating the surgical patients alone,5.8 of 100 person-years(P=.19).Conclusions:In trachoma-endemic areas,a single dose ofazithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline.Application to Clinical Practice:In countries where azithromycin is part of the Trachoma Control Program,patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Background： Trichiasis recurrence following surgery is a serious problem for trachoma programs. Objective： To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient. Design： A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1：1： 1 to the following 3 arms： single-dose （1 g） oral azithromycin alone, single-dose azithromycin for household members （20 mg/kg up to 1 g） plus the patient, or topical tetracycline （twice per day for 6 weeks） Main Outcome Measures： Trichiasis recurrence within 1 year following surgery. Results： The combined azithromycin groups had significantly fewer recurrences, 6. 9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 personyears （P =0. 047）. There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years （P=0. 19） Conclusions： In trachoma-endemic areas, a single dose ofazithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice： In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.