https://www.cidrap.umn.edu/news-perspective/2022/08/stewardship-resistance-scan-aug-23-2022
Stewardship / Resistance Scan for Aug 23, 2022
Mass azithromycin for trachoma;
Treatment efficacy for multidrug-resistant TB
Filed Under:
Antimicrobial Stewardship;
Tuberculosis
Trial finds no impact on trachoma from mass azithromycin distribution
A randomized clinical trial in Niger found that mass distribution of azithromycin to preschool-aged children was no more effective at reducing incidence of trachoma than placebo, researchers reported today in JAMA Network Open.
The cluster-randomized trial, conducted by investigators with the Macrolides Oraux pout Réduire les Décés Avec un Oeil sur la Resistance (MORDOR)-Niger Study Group, assessed the effects of biannual mass azithromycin distribution to children ages 1 to 59 months in 30 villages in a region of Niger thought to have hypoendemic trachoma. The World Health Organization (WHO) recommends mass distribution of azithromycin for districts with trachoma, the world's leading infectious cause of blindness, but concerns that mass antibiotic administration to entire communities could promote antibiotic resistance has led researchers to ask whether targeted distribution might be a better strategy.
A total of 4,756 children in 30 communities were included, with 1,695 children enrolled in 15 azithromycin communities and 3,031 in 15 placebo communities. Enrolled children received a single dose of oral azithromycin or oral placebo every 6 months over 24 months. The primary outcome of the trial was the incidence of trachomatous inflammation-follicular (TF).
The mean prevalence of TF at baseline was 1.9% (95% confidence interval [CI], 0.5% to 3.5%) in the azithromycin group and 0.9% (95% CI, 0 to 1.9%) in the placebo group. At 24 months, TF prevalence was 0.2% (95% CI, 0 to 0.5%) in the azithromycin group and 0.8% (95% CI, 0.2% to 1.6%) in the placebo group. The lower incidence of TF in the azithromycin group was not considered statistically significant (incidence rate ratio adjusted for baseline: 0.18 [95% CI, 0.01 to 1.20]).
The study authors say that the low baseline prevalence of trachoma in the communities makes it difficult to determine whether targeted mass distribution of azithromycin to preschool-aged children could be an effective strategy for trachoma elimination. It also suggests trachoma may have been eliminated as a public health problem in those communities.
"It remains unclear whether azithromycin distributions to preschool-aged children would be effective in other areas with hypoendemic trachoma that have slightly more infection than those assessed in the present study," they wrote.
Aug 23 JAMA Netw Open study
Multidrug-resistant TB treatment more effective than thought
A systematic review and meta-analysis of studies from countries in Central and West Africa found higher-than-expected treatment success rates for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB), researchers reported yesterday in the International Journal of Infectious Diseases.
The analysis of 14 studies from 14 countries in the two regions, published from 2005 through 2020 and including 4,268 people, found the overall treatment success was 74.6% (95% confidence interval [CI], 65% to 82.2%), with a pooled success rate of 80.8% (95% CI, 56% to 93.3%) for the Central African subgroup and 69.3% for the West African subgroup (95% CI, 56.3% to 79.7%). The estimated proportion of successfully treated MDR/RR-TB patients was significantly higher than the WHO's estimate of 59% and reaches the WHO's 2015 target of 75% treatment success for MDR-TB.
The findings are surprising because the studies were conducted while countries in the region were using the standard MDR-TB regimen, which lasts 18 to 24 months and includes injectable drugs. Poor adherence to that regimen has been associated with low treatment success rates. The authors note the findings may be explained by early introduction of a 9- to 11-month regimen in many of the included countries, along with the absence of data from 12 countries in the region.
"Whether this reflects the true rate of treatment success or whether the rate is skewed due to underreporting remains unknown," they wrote.
In 2022, the WHO endorsed a 6-month all-oral regimen for MDR-TB that experts hope will lead to even better treatment outcomes.
Aug 22 Int J Infect Dis study
Stewardship / Resistance Scan for Aug 23, 2022
Mass azithromycin for trachoma;
Treatment efficacy for multidrug-resistant TB
Filed Under:
Antimicrobial Stewardship;
Tuberculosis
Trial finds no impact on trachoma from mass azithromycin distribution
A randomized clinical trial in Niger found that mass distribution of azithromycin to preschool-aged children was no more effective at reducing incidence of trachoma than placebo, researchers reported today in JAMA Network Open.
The cluster-randomized trial, conducted by investigators with the Macrolides Oraux pout Réduire les Décés Avec un Oeil sur la Resistance (MORDOR)-Niger Study Group, assessed the effects of biannual mass azithromycin distribution to children ages 1 to 59 months in 30 villages in a region of Niger thought to have hypoendemic trachoma. The World Health Organization (WHO) recommends mass distribution of azithromycin for districts with trachoma, the world's leading infectious cause of blindness, but concerns that mass antibiotic administration to entire communities could promote antibiotic resistance has led researchers to ask whether targeted distribution might be a better strategy.
A total of 4,756 children in 30 communities were included, with 1,695 children enrolled in 15 azithromycin communities and 3,031 in 15 placebo communities. Enrolled children received a single dose of oral azithromycin or oral placebo every 6 months over 24 months. The primary outcome of the trial was the incidence of trachomatous inflammation-follicular (TF).
The mean prevalence of TF at baseline was 1.9% (95% confidence interval [CI], 0.5% to 3.5%) in the azithromycin group and 0.9% (95% CI, 0 to 1.9%) in the placebo group. At 24 months, TF prevalence was 0.2% (95% CI, 0 to 0.5%) in the azithromycin group and 0.8% (95% CI, 0.2% to 1.6%) in the placebo group. The lower incidence of TF in the azithromycin group was not considered statistically significant (incidence rate ratio adjusted for baseline: 0.18 [95% CI, 0.01 to 1.20]).
The study authors say that the low baseline prevalence of trachoma in the communities makes it difficult to determine whether targeted mass distribution of azithromycin to preschool-aged children could be an effective strategy for trachoma elimination. It also suggests trachoma may have been eliminated as a public health problem in those communities.
"It remains unclear whether azithromycin distributions to preschool-aged children would be effective in other areas with hypoendemic trachoma that have slightly more infection than those assessed in the present study," they wrote.
Aug 23 JAMA Netw Open study
Multidrug-resistant TB treatment more effective than thought
A systematic review and meta-analysis of studies from countries in Central and West Africa found higher-than-expected treatment success rates for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB), researchers reported yesterday in the International Journal of Infectious Diseases.
The analysis of 14 studies from 14 countries in the two regions, published from 2005 through 2020 and including 4,268 people, found the overall treatment success was 74.6% (95% confidence interval [CI], 65% to 82.2%), with a pooled success rate of 80.8% (95% CI, 56% to 93.3%) for the Central African subgroup and 69.3% for the West African subgroup (95% CI, 56.3% to 79.7%). The estimated proportion of successfully treated MDR/RR-TB patients was significantly higher than the WHO's estimate of 59% and reaches the WHO's 2015 target of 75% treatment success for MDR-TB.
The findings are surprising because the studies were conducted while countries in the region were using the standard MDR-TB regimen, which lasts 18 to 24 months and includes injectable drugs. Poor adherence to that regimen has been associated with low treatment success rates. The authors note the findings may be explained by early introduction of a 9- to 11-month regimen in many of the included countries, along with the absence of data from 12 countries in the region.
"Whether this reflects the true rate of treatment success or whether the rate is skewed due to underreporting remains unknown," they wrote.
In 2022, the WHO endorsed a 6-month all-oral regimen for MDR-TB that experts hope will lead to even better treatment outcomes.
Aug 22 Int J Infect Dis study