Fighting trachoma with antibiotic may prevent deaths in Ethiopia

[Shiloh]

Source: http://www.google.com/hostednews/ap/article/ALeqM5hPQxDoPjYkIIrTpQqzlONzZylBvwD9AENSG80

Fighting blindness may prevent deaths in Ethiopia

By CARLA K. JOHNSON (AP) ? 2 hours ago

CHICAGO ? An antibiotic widely used in Africa to treat eyesight-robbing infections seems to help prevent Ethiopian children from dying of other diseases. A study in Wednesday's Journal of the American Medical Association suggests an unintended benefit from efforts to wipe out trachoma, the world's leading preventable cause of blindness.

The World Health Organization has set 2020 as the target for eliminating trachoma. The United States has been free of the disease since the 1970s, but it persists in 48 countries. In Ethiopia, a hotbed, 40 percent of children under 10 show signs of active trachoma.

"Trachoma is almost part of the definition of poverty," said study co-author Paul Emerson of the Atlanta-based Carter Center. "Its victims are forgotten and without political voice, which is why this finding is so tremendously exciting."

The researchers compared villages where children received the antibiotic Zithromax to villages where treatment was delayed a year. The antibiotic cut the death rate in half, and the researchers speculate it helped prevent deaths from pneumonia, diarrhea and malaria, the biggest killers of Ethiopian children.

Among about 13,000 children in treated villages, there were 45 deaths. Among the 5,100 children in villages where treatment was delayed, there were 37 deaths.

Trachoma is caused by bacteria that spreads to the eyes from fingers, clothing or, some researchers think, from flies. Blindness develops over decades through repeated infections and scarring.

"Anything that has potential to reduce mortality is of large interest," said trachoma researcher Sheila West of Johns Hopkins' Wilmer Eye Institute in Baltimore. West was not involved in the new research.

The study would be stronger if it had compared death rates before and after the antibiotic treatment, she said. And she was puzzled there wasn't much difference in death rates among groups treated once, twice or four times during the year.

The study was funded by the National Institutes of Health. The International Trachoma Initiative supplied the antibiotic through donations from drugmaker Pfizer Inc.

The trachoma program of the Carter Center, founded by former President Jimmy Carter and former first lady Rosalynn Carter, implemented the treatment and hosted the research.

"This study shows trachoma control goes far beyond blindness prevention ? it also saves lives," the former president said in a statement.
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* JAMA: http://jama.ama-assn.org

 

[Shiloh]

Re: Fighting trachoma with antibiotic may prevent deaths in Ethiopia

Source: http://www.eurekalert.org/pub_releases/2009-09/jaaj-doa082709.php

Public release date: 1-Sep-2009
Contact: Karin Rush-Monroe
Karin.Rush-Monroe@ucsf.edu
415-502-1332
JAMA and Archives Journals

Distribution of antibiotic for eye disease linked to low death risk among Ethiopian children

This release is available in Chinese.

Children in Ethiopia who received the antibiotic azithromycin as a method for controlling the contagious eye disease trachoma had a lower odds of death compared to children who did not receive the antibiotic, according to a study in the September 2 issue of JAMA.

"The World Health Organization has recommended mass distribution and administration of oral azithromycin as part of efforts to control blinding trachoma. Such distribution has proven effective against the ocular strains of Chlamydia trachomatis that cause the disease at both the individual and village levels," the authors write. The treatment may also have unintended consequences, both harmful and beneficial, including the inducement of antibiotic resistance. "Conversely, antibiotics may reduce both respiratory and gastrointestinal infections, and possibly reduce rates of malaria?all of which are major causes of death in children in trachoma-endemic areas such as rural Ethiopia."

Travis C. Porco, Ph.D., M.P.H., of the University of California, San Francisco, and colleagues examined the effect of oral azithromycin distribution for trachoma control on mortality among children ages 1 to 9 in Ethiopia. Forty-eight communities (known as subkebeles) were randomized into 1 of 3 treatment schedules (annual treatment of all residents [15,902 participants], biannual treatment of all residents [17,288 participants], or quarterly treatment of children only [14,716 participants]) or into 1 group for which treatment was delayed by 1 year (control, 18,498 participants). Twelve subkebeles were randomized to each of the 4 schedules with all children in each of the three communities being eligible for treatment. The trial was conducted in a field setting in rural Ethiopia, May 2006 to May 2007. Antibiotic coverage rates exceeded 81 percent among children age 1 to 9 years at all visits.

A total of 82 deaths were recorded for children age 1 to 9 years at the 2007 census. Comparing the mortality rates between the two groups, the researchers found that the children in the treatment group had a 49 percent lower odds of death compared with children in the control group.

"It is not clear precisely why azithromycin decreased mortality, although infectious diseases are the leading cause of death in Ethiopian children, in particular pneumonia (28 percent), diarrhea (20 percent), and malaria (20 percent). In Ethiopia, azithromycin is likely effective against the major pathogenic causes of lower respiratory infections such as Streptococcus pneumoniae and Haemophilus influenzae, and may have some effect against major causes of bacterial diarrhea such as Escherichia coli and Clostridium jejuni. Azithromycin has also been shown to have efficacy in the prevention and treatment of malaria due to both Plasmodium falciparum and Plasmodium vivax," the authors write.

"The dangers of nonspecific antibiotic use have been well-described in the scientific literature. The common wisdom is that overprescribing antibiotics results in increased morbidity and mortality from drug-resistant organisms, and that society would be better off were physicians to restrain their use of the drugs. However, the effect of nonspecific mass antibiotic use on mortality has never before been assessed in a group-randomized clinical trial. In an area in which residents have very limited access to antibiotics, mass distribution of oral azithromycin appears to reduce mortality in preschool children. Further assessment of the mechanism, generalizability, effects of drug resistance or other adverse outcomes, and cost-effectiveness of antibiotic administration in impoverished rural settings may be needed to provide further insight to guide public health policy."

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(JAMA. 2009;302[9]:962-968. Available pre-embargo to the media at www.jamamedia.org)

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