Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea
Summary: Background: A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-04-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X18300238 |
| _version_ | 1818380888779522048 |
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| author | Michael Marks, PhD Oriol Mitjà, PhD Christian Bottomley, PhD Cynthia Kwakye, PhD Wendy Houinei, DPH Mathias Bauri, MPH Paul Adwere, MPH Abdul A Abdulai, MPH Fredrick Dua, MD Laud Boateng, MPH James Wangi, MD Sally-Ann Ohene, MPH Regina Wangnapi, MD Shirley V Simpson, MPhil Helen Miag, HEO Kennedy K Addo, ProfPhD Laud A Basing, MPhil Damien Danavall, BSc Kai H Chi, MSc Allan Pillay, PhD Ronald Ballard, ProfPhD Anthony W Solomon, PhD Cheng Y Chen, PhD Sibauk V Bieb, MAHM Yaw Adu-Sarkodie, ProfPhD David C W Mabey, ProfFRCP Kingsley Asiedu, MPH Michael Marks Oriol Mitjà Christian Bottomley Cynthia Kwakye Wendy Hounei Mathias Bauri Paul Adwere Abdul A Abdulai Fredrick Dua Laud Boateng James Wangi Sayy-Ann Ohene Regina Wangnapi Shirley V Simpson Helen Miag Kennedy K Addo Laud A Basing Damien Danavall Kai H Chi Allan Pillay Ronald Ballard Anthony W Solomon Cheng Y Chen Sivuak V Bieb Yaw Adu-Sarkodie David CW Mabey Kingsley Asiedu Nsire Agana Edwin Ampadu Kwame Amponsah-Achiano Asare Bediako Michael Biredu Kyei Faried Ahmed Iddrisu Nana K Kotey George NY Yeboah Philip El-Duah Richard Phillips Fred Binka Frank Nyonator Anthony Zunuo Mercy A Ackumey Ivy Amanor Christian Bnosu Sieghard Frischmann Patrick Lammie Diana Martin Tun Ye Eva Christophel Alexandre Tiendrebeogo Lasse Vestergard Quique Bassat Yazid Abdad Henson Dima Bethuel Kotty Kaiok Mamore Walerius Manup Benson Olowau Enoch O Agyei David Agyemang Ebenezer P Ako Prince Antwi Jane Darko Ophelia O Darko Phylis Darko Bertha Duodu Daniel Jabasi Fuseini L Karim Obed K Koomson Bernard A Labri John Nartey Randsford Tamatey Benjamin Yirenkyi Mercy Arhin Frank Biney Juliana O Danso Martin A Dei Moses Djan Samuel Sasu Brefo A Solomon Victor Torvinya Hagar Amankwaah James Baffoe Moses Djan Lydia Keteku Kofi Kondobala Rita D Lomotey Augustina A Nartey Paul Oppong Millicent A Quainoo Theophilus Abotsi Dzighordi Agebshie Amos Ameamu Paul Angwaawie Rose Ayibor Margaret Mwingmendeli John Nakodia Amatus Nambagyira Dominic Nanga Nichola Tetteh Augustine Wanaom |
| author_facet | Michael Marks, PhD Oriol Mitjà, PhD Christian Bottomley, PhD Cynthia Kwakye, PhD Wendy Houinei, DPH Mathias Bauri, MPH Paul Adwere, MPH Abdul A Abdulai, MPH Fredrick Dua, MD Laud Boateng, MPH James Wangi, MD Sally-Ann Ohene, MPH Regina Wangnapi, MD Shirley V Simpson, MPhil Helen Miag, HEO Kennedy K Addo, ProfPhD Laud A Basing, MPhil Damien Danavall, BSc Kai H Chi, MSc Allan Pillay, PhD Ronald Ballard, ProfPhD Anthony W Solomon, PhD Cheng Y Chen, PhD Sibauk V Bieb, MAHM Yaw Adu-Sarkodie, ProfPhD David C W Mabey, ProfFRCP Kingsley Asiedu, MPH Michael Marks Oriol Mitjà Christian Bottomley Cynthia Kwakye Wendy Hounei Mathias Bauri Paul Adwere Abdul A Abdulai Fredrick Dua Laud Boateng James Wangi Sayy-Ann Ohene Regina Wangnapi Shirley V Simpson Helen Miag Kennedy K Addo Laud A Basing Damien Danavall Kai H Chi Allan Pillay Ronald Ballard Anthony W Solomon Cheng Y Chen Sivuak V Bieb Yaw Adu-Sarkodie David CW Mabey Kingsley Asiedu Nsire Agana Edwin Ampadu Kwame Amponsah-Achiano Asare Bediako Michael Biredu Kyei Faried Ahmed Iddrisu Nana K Kotey George NY Yeboah Philip El-Duah Richard Phillips Fred Binka Frank Nyonator Anthony Zunuo Mercy A Ackumey Ivy Amanor Christian Bnosu Sieghard Frischmann Patrick Lammie Diana Martin Tun Ye Eva Christophel Alexandre Tiendrebeogo Lasse Vestergard Quique Bassat Yazid Abdad Henson Dima Bethuel Kotty Kaiok Mamore Walerius Manup Benson Olowau Enoch O Agyei David Agyemang Ebenezer P Ako Prince Antwi Jane Darko Ophelia O Darko Phylis Darko Bertha Duodu Daniel Jabasi Fuseini L Karim Obed K Koomson Bernard A Labri John Nartey Randsford Tamatey Benjamin Yirenkyi Mercy Arhin Frank Biney Juliana O Danso Martin A Dei Moses Djan Samuel Sasu Brefo A Solomon Victor Torvinya Hagar Amankwaah James Baffoe Moses Djan Lydia Keteku Kofi Kondobala Rita D Lomotey Augustina A Nartey Paul Oppong Millicent A Quainoo Theophilus Abotsi Dzighordi Agebshie Amos Ameamu Paul Angwaawie Rose Ayibor Margaret Mwingmendeli John Nakodia Amatus Nambagyira Dominic Nanga Nichola Tetteh Augustine Wanaom |
| author_sort | Michael Marks, PhD |
| collection | DOAJ |
| description | Summary: Background: A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. Methods: We did a non-inferiority, open-label, randomised controlled trial in children aged 6–15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. Findings: Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI −8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. Interpretation: In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. Funding: Coalition for Operational Research on Neglected Tropical Diseases. |
| first_indexed | 2024-12-14T02:25:51Z |
| format | Article |
| id | doaj.art-80d8729e29194b8a92aac058ab687ea6 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-14T02:25:51Z |
| publishDate | 2018-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-80d8729e29194b8a92aac058ab687ea62022-12-21T23:20:23ZengElsevierThe Lancet Global Health2214-109X2018-04-0164e401e410Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New GuineaMichael Marks, PhD0Oriol Mitjà, PhD1Christian Bottomley, PhD2Cynthia Kwakye, PhD3Wendy Houinei, DPH4Mathias Bauri, MPH5Paul Adwere, MPH6Abdul A Abdulai, MPH7Fredrick Dua, MD8Laud Boateng, MPH9James Wangi, MD10Sally-Ann Ohene, MPH11Regina Wangnapi, MD12Shirley V Simpson, MPhil13Helen Miag, HEO14Kennedy K Addo, ProfPhD15Laud A Basing, MPhil16Damien Danavall, BSc17Kai H Chi, MSc18Allan Pillay, PhD19Ronald Ballard, ProfPhD20Anthony W Solomon, PhD21Cheng Y Chen, PhD22Sibauk V Bieb, MAHM23Yaw Adu-Sarkodie, ProfPhD24David C W Mabey, ProfFRCP25Kingsley Asiedu, MPH26Michael MarksOriol MitjàChristian BottomleyCynthia KwakyeWendy HouneiMathias BauriPaul AdwereAbdul A AbdulaiFredrick DuaLaud BoatengJames WangiSayy-Ann OheneRegina WangnapiShirley V SimpsonHelen MiagKennedy K AddoLaud A BasingDamien DanavallKai H ChiAllan PillayRonald BallardAnthony W SolomonCheng Y ChenSivuak V BiebYaw Adu-SarkodieDavid CW MabeyKingsley AsieduNsire AganaEdwin AmpaduKwame Amponsah-AchianoAsare BediakoMichael BireduKyei FariedAhmed IddrisuNana K KoteyGeorge NY YeboahPhilip El-DuahRichard PhillipsFred BinkaFrank NyonatorAnthony ZunuoMercy A AckumeyIvy AmanorChristian BnosuSieghard FrischmannPatrick LammieDiana MartinTun YeEva ChristophelAlexandre TiendrebeogoLasse VestergardQuique BassatYazid AbdadHenson DimaBethuel KottyKaiok MamoreWalerius ManupBenson OlowauEnoch O AgyeiDavid AgyemangEbenezer P AkoPrince AntwiJane DarkoOphelia O DarkoPhylis DarkoBertha DuoduDaniel JabasiFuseini L KarimObed K KoomsonBernard A LabriJohn NarteyRandsford TamateyBenjamin YirenkyiMercy ArhinFrank BineyJuliana O DansoMartin A DeiMoses DjanSamuel SasuBrefo A SolomonVictor TorvinyaHagar AmankwaahJames BaffoeMoses DjanLydia KetekuKofi KondobalaRita D LomoteyAugustina A NarteyPaul OppongMillicent A QuainooTheophilus AbotsiDzighordi AgebshieAmos AmeamuPaul AngwaawieRose AyiborMargaret MwingmendeliJohn NakodiaAmatus NambagyiraDominic NangaNichola TettehAugustine WanaomClinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK; Correspondence to: Dr Michael Marks, Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UKBarcelona Institute for Global Health, University of Barcelona, Barcelona, Spain; Lihir Medical Centre, International SOS, Newcrest Mining, Lihir Island, Papua New GuineaMRC Tropical Epidemiology Group, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UKGhana Health Services, Accra, GhanaDepartment of Health, Port Moresby, Papua New GuineaDepartment of Health, Port Moresby, Papua New GuineaGhana Health Services, Accra, GhanaGhana Health Services, Accra, GhanaGhana Health Services, Accra, GhanaGhana Health Services, Accra, GhanaWorld Health Organization Country Office, Port Moresby, Papua New GuineaWorld Health Organization Country Office, Accra, GhanaPapua New Guinea Institute of Medical Research, Goroka, Papua New GuineaNoguchi Memorial Institute for Medical Research, Accra, GhanaDepartment of Health, Port Moresby, Papua New GuineaNoguchi Memorial Institute for Medical Research, Accra, GhanaKwame Nkrumah University of Science and Technology, Kumasi, GhanaMolecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USAMolecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USAMolecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USACenter for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USADepartment of Control of Neglected Tropical Diseases, World Health Organization, Geneva, SwitzerlandMolecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USADepartment of Public Health, National Department of Health, Waigani, Papua New GuineaKwame Nkrumah University of Science and Technology, Kumasi, GhanaClinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UKDepartment of Control of Neglected Tropical Diseases, World Health Organization, Geneva, SwitzerlandSummary: Background: A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. Methods: We did a non-inferiority, open-label, randomised controlled trial in children aged 6–15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. Findings: Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI −8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. Interpretation: In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. Funding: Coalition for Operational Research on Neglected Tropical Diseases.http://www.sciencedirect.com/science/article/pii/S2214109X18300238 |
| spellingShingle | Michael Marks, PhD Oriol Mitjà, PhD Christian Bottomley, PhD Cynthia Kwakye, PhD Wendy Houinei, DPH Mathias Bauri, MPH Paul Adwere, MPH Abdul A Abdulai, MPH Fredrick Dua, MD Laud Boateng, MPH James Wangi, MD Sally-Ann Ohene, MPH Regina Wangnapi, MD Shirley V Simpson, MPhil Helen Miag, HEO Kennedy K Addo, ProfPhD Laud A Basing, MPhil Damien Danavall, BSc Kai H Chi, MSc Allan Pillay, PhD Ronald Ballard, ProfPhD Anthony W Solomon, PhD Cheng Y Chen, PhD Sibauk V Bieb, MAHM Yaw Adu-Sarkodie, ProfPhD David C W Mabey, ProfFRCP Kingsley Asiedu, MPH Michael Marks Oriol Mitjà Christian Bottomley Cynthia Kwakye Wendy Hounei Mathias Bauri Paul Adwere Abdul A Abdulai Fredrick Dua Laud Boateng James Wangi Sayy-Ann Ohene Regina Wangnapi Shirley V Simpson Helen Miag Kennedy K Addo Laud A Basing Damien Danavall Kai H Chi Allan Pillay Ronald Ballard Anthony W Solomon Cheng Y Chen Sivuak V Bieb Yaw Adu-Sarkodie David CW Mabey Kingsley Asiedu Nsire Agana Edwin Ampadu Kwame Amponsah-Achiano Asare Bediako Michael Biredu Kyei Faried Ahmed Iddrisu Nana K Kotey George NY Yeboah Philip El-Duah Richard Phillips Fred Binka Frank Nyonator Anthony Zunuo Mercy A Ackumey Ivy Amanor Christian Bnosu Sieghard Frischmann Patrick Lammie Diana Martin Tun Ye Eva Christophel Alexandre Tiendrebeogo Lasse Vestergard Quique Bassat Yazid Abdad Henson Dima Bethuel Kotty Kaiok Mamore Walerius Manup Benson Olowau Enoch O Agyei David Agyemang Ebenezer P Ako Prince Antwi Jane Darko Ophelia O Darko Phylis Darko Bertha Duodu Daniel Jabasi Fuseini L Karim Obed K Koomson Bernard A Labri John Nartey Randsford Tamatey Benjamin Yirenkyi Mercy Arhin Frank Biney Juliana O Danso Martin A Dei Moses Djan Samuel Sasu Brefo A Solomon Victor Torvinya Hagar Amankwaah James Baffoe Moses Djan Lydia Keteku Kofi Kondobala Rita D Lomotey Augustina A Nartey Paul Oppong Millicent A Quainoo Theophilus Abotsi Dzighordi Agebshie Amos Ameamu Paul Angwaawie Rose Ayibor Margaret Mwingmendeli John Nakodia Amatus Nambagyira Dominic Nanga Nichola Tetteh Augustine Wanaom Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea The Lancet Global Health |
| title | Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea |
| title_full | Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea |
| title_fullStr | Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea |
| title_full_unstemmed | Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea |
| title_short | Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea |
| title_sort | comparative efficacy of low dose versus standard dose azithromycin for patients with yaws a randomised non inferiority trial in ghana and papua new guinea |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X18300238 |
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comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT edwinampadu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT kwameamponsahachiano comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT asarebediako comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT michaelbiredu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT kyeifaried comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT ahmediddrisu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT nanakkotey comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT georgenyyeboah comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT philipelduah comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT richardphillips comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT fredbinka comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT franknyonator comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT anthonyzunuo comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT mercyaackumey comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT ivyamanor comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT christianbnosu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT sieghardfrischmann comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT patricklammie comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT dianamartin comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT tunye comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT evachristophel comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT alexandretiendrebeogo comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT lassevestergard comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT quiquebassat comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT yazidabdad comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT hensondima comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT bethuelkotty comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT kaiokmamore comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT waleriusmanup comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT bensonolowau comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT enochoagyei comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT davidagyemang comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT ebenezerpako comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT princeantwi comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT janedarko comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT opheliaodarko comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT phylisdarko comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT berthaduodu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT danieljabasi comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT fuseinilkarim comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT obedkkoomson comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT bernardalabri comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT johnnartey comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT randsfordtamatey comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT benjaminyirenkyi comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT mercyarhin comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT frankbiney comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT julianaodanso comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT martinadei comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT mosesdjan comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT samuelsasu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT brefoasolomon comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT victortorvinya comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT hagaramankwaah comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT jamesbaffoe comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT mosesdjan comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT lydiaketeku comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT kofikondobala comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT ritadlomotey comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT augustinaanartey comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT pauloppong comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT millicentaquainoo comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT theophilusabotsi comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT dzighordiagebshie comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT amosameamu comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT paulangwaawie comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT roseayibor comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT margaretmwingmendeli comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT johnnakodia comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT amatusnambagyira comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT dominicnanga comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT nicholatetteh comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea AT augustinewanaom comparativeefficacyoflowdoseversusstandarddoseazithromycinforpatientswithyawsarandomisednoninferioritytrialinghanaandpapuanewguinea |