The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial
Mass oral azithromycin distributions have dramatically reduced the prevalence of the ocular strains of chlamydia that cause trachoma. Assessing efficacy of the antibiotic in an individual is important in planning trachoma elimination. However, the efficacy is difficult to estimate, because post-trea...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2014-03-01
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| Series: | Epidemics |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1755436513000534 |
| _version_ | 1811277123639312384 |
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| author | Fengchen Liu Travis C. Porco Harran A. Mkocha Beatriz Muñoz Kathryn J. Ray Robin L. Bailey Thomas M. Lietman Sheila K. West |
| author_facet | Fengchen Liu Travis C. Porco Harran A. Mkocha Beatriz Muñoz Kathryn J. Ray Robin L. Bailey Thomas M. Lietman Sheila K. West |
| author_sort | Fengchen Liu |
| collection | DOAJ |
| description | Mass oral azithromycin distributions have dramatically reduced the prevalence of the ocular strains of chlamydia that cause trachoma. Assessing efficacy of the antibiotic in an individual is important in planning trachoma elimination. However, the efficacy is difficult to estimate, because post-treatment laboratory testing may be complicated by nonviable organisms or reinfection. Here, we monitored ocular chlamydial infection twice a year in pre-school children in 32 communities as part of a cluster-randomized clinical trial in Tanzania (prevalence in children was lowered from 22.0% to 4.7% after 3-year of annual treatment). We used a mathematical transmission model to estimate the prevalence of infection immediately after treatment, and found the effective field efficacy of antibiotic in an individual to be 67.6% (95% CI: 56.5–75.1%) in this setting. Sensitivity analyses suggested that these results were not dependent on specific assumptions about the duration of infection. We found no evidence of decreased efficacy during the course of the trial. We estimated an 89% chance of elimination after 10 years of annual treatment with 95% coverage. |
| first_indexed | 2024-04-13T00:10:03Z |
| format | Article |
| id | doaj.art-36e44d3ddabd48cfaa725dccadc3fd52 |
| institution | Directory Open Access Journal |
| issn | 1755-4365 1878-0067 |
| language | English |
| last_indexed | 2024-04-13T00:10:03Z |
| publishDate | 2014-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Epidemics |
| spelling | doaj.art-36e44d3ddabd48cfaa725dccadc3fd522022-12-22T03:11:07ZengElsevierEpidemics1755-43651878-00672014-03-016C101710.1016/j.epidem.2013.12.001The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trialFengchen Liu0Travis C. Porco1Harran A. Mkocha2Beatriz Muñoz3Kathryn J. Ray4Robin L. Bailey5Thomas M. Lietman6Sheila K. West7F.I. Proctor Foundation, University of California, San Francisco, CA, USAF.I. Proctor Foundation, University of California, San Francisco, CA, USAKongwa Trachoma Project, Kongwa, TanzaniaWilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USAF.I. Proctor Foundation, University of California, San Francisco, CA, USAFaculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical and Medicine, London, UKF.I. Proctor Foundation, University of California, San Francisco, CA, USAWilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USAMass oral azithromycin distributions have dramatically reduced the prevalence of the ocular strains of chlamydia that cause trachoma. Assessing efficacy of the antibiotic in an individual is important in planning trachoma elimination. However, the efficacy is difficult to estimate, because post-treatment laboratory testing may be complicated by nonviable organisms or reinfection. Here, we monitored ocular chlamydial infection twice a year in pre-school children in 32 communities as part of a cluster-randomized clinical trial in Tanzania (prevalence in children was lowered from 22.0% to 4.7% after 3-year of annual treatment). We used a mathematical transmission model to estimate the prevalence of infection immediately after treatment, and found the effective field efficacy of antibiotic in an individual to be 67.6% (95% CI: 56.5–75.1%) in this setting. Sensitivity analyses suggested that these results were not dependent on specific assumptions about the duration of infection. We found no evidence of decreased efficacy during the course of the trial. We estimated an 89% chance of elimination after 10 years of annual treatment with 95% coverage.http://www.sciencedirect.com/science/article/pii/S1755436513000534Mathematical modelEliminationAzithromycinSAFE strategyTrachoma |
| spellingShingle | Fengchen Liu Travis C. Porco Harran A. Mkocha Beatriz Muñoz Kathryn J. Ray Robin L. Bailey Thomas M. Lietman Sheila K. West The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial Epidemics Mathematical model Elimination Azithromycin SAFE strategy Trachoma |
| title | The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial |
| title_full | The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial |
| title_fullStr | The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial |
| title_full_unstemmed | The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial |
| title_short | The efficacy of oral azithromycin in clearing ocular chlamydia: Mathematical modeling from a community-randomized trachoma trial |
| title_sort | efficacy of oral azithromycin in clearing ocular chlamydia mathematical modeling from a community randomized trachoma trial |
| topic | Mathematical model Elimination Azithromycin SAFE strategy Trachoma |
| url | http://www.sciencedirect.com/science/article/pii/S1755436513000534 |
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