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 ofazithromycinreducedpostoperative 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.