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Dulli L, Touré F, Mama AD, Evens E, Murray K, Djè NN, Koné S, Sadate-Ngatchou P, Bovary A, Eichleay M, Jean-Baptiste M, Méité A. Feasibility and acceptability of integrating mass distribution of azithromycin to children 1-11 months into a trachoma mass drug administration campaign to reduce child mortality in Côte d'Ivoire. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003426. [PMID: 38985785 PMCID: PMC11236188 DOI: 10.1371/journal.pgph.0003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
Evidence suggests that bi-annual mass drug administration (MDA) of single-dose azithromycin to 1-11 month-old children reduces child mortality in high child-mortality settings. Several countries conduct annual MDAs to distribute azithromycin to individuals ages 6 months and older to prevent trachoma infection. This study examined the feasibility and acceptability of reaching 1-11 months-old children during a trachoma MDA in Côte d'Ivoire by extending azithromycin distribution to infants 1-5 months old during the campaign. In November 2020, the study piloted single-dose azithromycin for 1-5 month-olds during a trachoma MDA in one health district. Monitoring data included the number of children reached and occurrences of adverse drug reactions. Feasibility, the extent to which the target population received the intervention (coverage), was assessed through a population-based, household survey with parents/caregivers of eligible children conducted after the MDA. Acceptability was explored through in-depth interviews (IDIs) with parents/caregivers of eligible children, focus group discussions (FGDs) with community drug distributors (CDDs), and IDIs with their supervisors. CDD FGDs and supervisor IDIs also documented implementation challenges and recommendations for scale-up. 1,735 1-5 month-olds received azithromycin during the pilot activity (estimated population coverage of 90.2%). Adverse drug reactions were reported for 1% (n = 18) infants; all were mild and self-limited. The post-MDA coverage survey interviewed 267 parents/caregivers; survey-based intervention coverage was 95.4% of 1-5 month-olds. Qualitative data revealed high intervention acceptability among parents, CDDs, and supervisors. Implementation challenges included the need to weigh babies to calculate dosage for 1-5 month-olds and the need to obtain written informed consent from parents to provide the drug to 1-5 month-olds. CDDs also indicated the need for more information on azithromycin and possible side effects during training. Delivering azithromycin to younger infants appears acceptable to parents and implementers; >90% coverage indicates feasibility to integrate into a trachoma MDA. (Clinicaltrials.gov ID number: NCT04617626).
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Affiliation(s)
- Lisa Dulli
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Fatoumata Touré
- Global Health and Population Business Unit, FHI 360, Abidjan, Côte d'Ivoire
| | - Adam Djima Mama
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
| | - Emily Evens
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Kate Murray
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Norbert N'goran Djè
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
| | - Stéphane Koné
- Global Health and Population Business Unit, FHI 360, Abidjan, Côte d'Ivoire
| | - Pat Sadate-Ngatchou
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Anoma Bovary
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
| | - Marga Eichleay
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Milenka Jean-Baptiste
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Aboulaye Méité
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
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Torres-Fernandez D, Dalsuco J, Bramugy J, Bassat Q, Varo R. Innovative strategies for the surveillance, prevention, and management of pediatric infections applied to low-income settings. Expert Rev Anti Infect Ther 2024; 22:413-422. [PMID: 38739471 DOI: 10.1080/14787210.2024.2354839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Infectious diseases still cause a significant burden of morbidity and mortality among children in low- and middle-income countries (LMICs). There are ample opportunities for innovation in surveillance, prevention, and management, with the ultimate goal of improving survival. AREAS COVERED This review discusses the current status in the use and development of innovative strategies for pediatric infectious diseases in LMICs by focusing on surveillance, diagnosis, prevention, and management. Topics covered are: Minimally Invasive Tissue Sampling as a technique to accurately ascertain the cause of death; Genetic Surveillance to trace the pathogen genomic diversity and emergence of resistance; Artificial Intelligence as a multidisciplinary tool; Portable noninvasive imaging methods; and Prognostic Biomarkers to triage and risk stratify pediatric patients. EXPERT OPINION To overcome the specific hurdles in child health for LMICs, some innovative strategies appear at the forefront of research. If the development of these next-generation tools remains focused on accessibility, sustainability and capacity building, reshaping epidemiological surveillance, diagnosis, and treatment in LMICs, can become a reality and result in a significant public health impact. Their integration with existing healthcare infrastructures may revolutionize disease detection and surveillance, and improve child health and survival.
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Affiliation(s)
- David Torres-Fernandez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Jessica Dalsuco
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Pg. Lluís Companys, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Lewnard JA, Charani E, Gleason A, Hsu LY, Khan WA, Karkey A, Chandler CIR, Mashe T, Khan EA, Bulabula ANH, Donado-Godoy P, Laxminarayan R. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet 2024; 403:2439-2454. [PMID: 38797180 DOI: 10.1016/s0140-6736(24)00862-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200-465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000-337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400-206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6-11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7-8·0) by water, sanitation, and hygiene, and 4·2% (3·4-5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alec Gleason
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Clare I R Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe; Health System Strengthening Unit, WHO, Harare, Zimbabwe
| | - Ejaz Ahmed Khan
- Department of Pediatrics, Shifa Tameer-e-Millat University, Shifa International Hospital, Islamabad, Pakistan
| | - Andre N H Bulabula
- Division of Disease Control and Prevention, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Pilar Donado-Godoy
- AMR Global Health Research Unit, Colombian Integrated Program of Antimicrobial Resistance Surveillance, Corporación Colombiana de Investigación Agropecuaria, Cundinamarca, Colombia
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Dionne JA, Anchang-Kimbi J, Hao J, Long D, Apinjoh T, Tih P, Mbah R, Ngah EN, Juliano JJ, Kahn M, Bruxvoort K, Van Der Pol B, Tita ATN, Marrazzo J, Achidi E. Trimethoprim-Sulfamethoxazole Plus Azithromycin to Prevent Malaria and Sexually Transmitted Infections in Pregnant Women With HIV (PREMISE): A Randomized, Double-Masked, Placebo-Controlled, Phase IIB Clinical Trial. Open Forum Infect Dis 2024; 11:ofae274. [PMID: 38807754 PMCID: PMC11130525 DOI: 10.1093/ofid/ofae274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/06/2024] [Indexed: 05/30/2024] Open
Abstract
Background This trial tested the effectiveness of a novel regimen to prevent malaria and sexually transmitted infections (STIs) among pregnant women with HIV in Cameroon. Our hypothesis was that the addition of azithromycin (AZ) to standard daily trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis would reduce malaria and STI infection rates at delivery. Methods Pregnant women with HIV at gestational age <28 weeks were randomized to adjunctive monthly oral AZ 1 g daily or placebo for 3 days and both groups received daily standard oral TMP-SMX through delivery. Primary outcomes were (1) positive peripheral malaria infection by microscopy or polymerase chain reaction and (2) composite bacterial genital STI (Chlamydia trachomatis, Neisseria gonorrhoeae, or syphilis) at delivery. Relative risk and 95% confidence intervals were estimated using 2 × 2 tables with significance as P < .05. Results Pregnant women with HIV (n = 308) were enrolled between March 2018 and August 2020: 155 women were randomized to TMP-SMX-AZ and 153 women to TMP-SMX-placebo. Groups were similar at baseline and loss to follow up was 3.2%. There was no difference in the proportion with malaria (16.3% in TMP-SMX-AZ vs 13.2% in TMP-SMX; relative risk, 1.24 [95% confidence interval, .71-2.16]) or STI at delivery (4.2% in TMP-SMX-AZ vs 5.8% in TMP-SMX; relative risk, 0.72 [95% confidence interval, .26-2.03]). Adverse birth outcomes were not significantly different, albeit lower in the TMP-SMX-AZ arm (preterm delivery 6.7% vs 10.7% [P = .3]; low birthweight 3.4% vs 5.4% [P = .6]). Conclusions The addition of monthly azithromycin to daily TMP-SMX prophylaxis in pregnant women living with HIV in Cameroon did not reduce the risk of malaria or bacterial STI at delivery.
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Affiliation(s)
- Jodie A Dionne
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jiaying Hao
- Departments of Biostatistics and Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dustin Long
- Departments of Biostatistics and Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias Apinjoh
- Department of Parasitology and Immunology, University of Buea, Buea, Cameroon
| | - Pius Tih
- Cameroon Baptist Convention Health Services, Cameroon Health Initiative at UAB, Bamenda, Cameroon
| | - Rahel Mbah
- Cameroon Baptist Convention Health Services, Cameroon Health Initiative at UAB, Bamenda, Cameroon
| | - Edward Ndze Ngah
- Cameroon Baptist Convention Health Services, Cameroon Health Initiative at UAB, Bamenda, Cameroon
| | - Jonathan J Juliano
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mauricio Kahn
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katia Bruxvoort
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Departments of Biostatistics and Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barbara Van Der Pol
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alan T N Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeanne Marrazzo
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric Achidi
- Department of Parasitology and Immunology, University of Buea, Buea, Cameroon
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Arzika AM, Abdou A, Maliki R, Beido N, Kadri B, Harouna AN, Galo AN, Alio MK, Lebas E, Oldenburg CE, O’Brien KS, Chen C, Zhong L, Zhou Z, Yan D, Hinterwirth A, Keenan JD, Porco TC, Lietman TM, Doan T. Prolonged mass azithromycin distributions and macrolide resistance determinants among preschool children in Niger: A sub-study of a cluster-randomized trial (MORDOR). PLoS Med 2024; 21:e1004386. [PMID: 38709718 PMCID: PMC11073710 DOI: 10.1371/journal.pmed.1004386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Randomized controlled trials found that twice-yearly mass azithromycin administration (MDA) reduces childhood mortality, presumably by reducing infection burden. World Health Organization (WHO) issued conditional guidelines for mass azithromycin administration in high-mortality settings in sub-Saharan Africa given concerns for antibiotic resistance. While prolonged twice-yearly MDA has been shown to increase antibiotic resistance in small randomized controlled trials, the objective of this study was to determine if macrolide and non-macrolide resistance in the gut increases with the duration of azithromycin MDA in a larger setting. METHODS AND FINDINGS The Macrolide Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) study was conducted in Niger from December 2014 to June 2020. It was a cluster-randomized trial of azithromycin (A) versus placebo (P) aimed at evaluating childhood mortality. This is a sub-study in the MORDOR trial to track changes in antibiotic resistance after prolonged azithromycin MDA. A total of 594 communities were eligible. Children 1 to 59 months in 163 randomly chosen communities were eligible to receive treatment and included in resistance monitoring. Participants, staff, and investigators were masked to treatment allocation. At the conclusion of MORDOR Phase I, by design, all communities received an additional year of twice-yearly azithromycin treatments (Phase II). Thus, at the conclusion of Phase II, the treatment history (1 letter per 6-month period) for the participating communities was either (PP-PP-AA) or (AA-AA-AA). In Phase III, participating communities were then re-randomized to receive either another 3 rounds of azithromycin or placebo, thus resulting in 4 treatment histories: Group 1 (AA-AA-AA-AA-A, N = 51), Group 2 (PP-PP-AA-AA-A, N = 40), Group 3 (AA-AA-AA-PP-P, N = 27), and Group 4 (PP-PP-AA-PP-P, N = 32). Rectal swabs from each child (N = 5,340) were obtained 6 months after the last treatment. Each child contributed 1 rectal swab and these were pooled at the community level, processed for DNA-seq, and analyzed for genetic resistance determinants. The primary prespecified outcome was macrolide resistance determinants in the gut. Secondary outcomes were resistance to beta-lactams and other antibiotic classes. Communities recently randomized to azithromycin (groups 1 and 2) had significantly more macrolide resistance determinants than those recently randomized to placebo (groups 3 and 4) (fold change 2.18, 95% CI 1.5 to 3.51, Punadj < 0.001). However, there was no significant increase in macrolide resistance in communities treated 4.5 years (group 1) compared to just the most recent 2.5 years (group 2) (fold change 0.80, 95% CI 0.50 to 1.00, Padj = 0.010), or between communities that had been treated for 3 years in the past (group 3) versus just 1 year in the past (group 4) (fold change 1.00, 95% CI 0.78 to 2.35, Padj = 0.52). We also found no significant differences for beta-lactams or other antibiotic classes. The main limitations of our study were the absence of phenotypic characterization of resistance, no complete placebo arm, and no monitoring outside of Niger limiting generalizability. CONCLUSIONS In this study, we observed that mass azithromycin distribution for childhood mortality among preschool children in Niger increased macrolide resistance determinants in the gut but that resistance may plateau after 2 to 3 years of treatment. Co-selection to other classes needs to be monitored. TRIAL REGISTRATION NCT02047981 https://classic.clinicaltrials.gov/ct2/show/NCT02047981.
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Affiliation(s)
| | - Amza Abdou
- Programme National de Santé Oculaire, Niamey, Niger
| | | | | | | | | | | | | | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
| | - Kieran S. O’Brien
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
| | - Cindi Chen
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Lina Zhong
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Zhaoxia Zhou
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Daisy Yan
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Armin Hinterwirth
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Jeremy D. Keenan
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Travis C. Porco
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
| | - Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
| | - Thuy Doan
- Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
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Oldenburg CE, Ouattara M, Bountogo M, Boudo V, Ouedraogo T, Compaoré G, Dah C, Zakane A, Coulibaly B, Bagagnan C, Hu H, O’Brien KS, Nyatigo F, Keenan JD, Doan T, Porco TC, Arnold BF, Lebas E, Sié A, Lietman TM. Mass Azithromycin Distribution to Prevent Child Mortality in Burkina Faso: The CHAT Randomized Clinical Trial. JAMA 2024; 331:482-490. [PMID: 38349371 PMCID: PMC10865159 DOI: 10.1001/jama.2023.27393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
Importance Repeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions. Objective To evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention. Design, Setting, and Participants This cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities. Interventions Communities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023. Main Outcomes and Measures The primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census. Results A total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1% (16.0%) of the censused children received the scheduled study drug in the azithromycin group and 89.8% (17.1%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95% CI, 0.57-0.94) in those aged 24 to 59 months. Conclusions and Relevance Mortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference. Trial Registration ClinicalTrials.gov Identifier: NCT03676764.
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Affiliation(s)
- Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
| | | | | | | | | | | | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | | | | | | | - Huiyu Hu
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Fanice Nyatigo
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
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7
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Cochrane GM, Mangot M, Houinei W, Susapu M, Cama A, Le Mesurier R, Webster S, Hillgrove T, Barton J, Butcher R, Harding-Esch EM, Mabey D, Bakhtiari A, Müller A, Yajima A, Solomon AW, Kaldor J, Koim SP, Ko R, Garap J. Corneal pannus, Herbert's pits and conjunctival inflammation in older children in Papua New Guinea. Ophthalmic Epidemiol 2024:1-8. [PMID: 38329811 DOI: 10.1080/09286586.2023.2273507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE The prevalence of trachomatous inflammation-follicular (TF) in Papua New Guinea (PNG) suggests antibiotic mass drug administration (MDA) is needed to eliminate trachoma as a public health problem but the burden of trichiasis is low. As a result, WHO issued bespoke recommendations for the region. If ≥ 20% of 10-14-year-olds have both any conjunctival scarring (C1 or C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. Equally, if ≥ 5% of that group have both moderate/severe conjunctival scarring (C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. METHODS We identified 14 villages where > 20% of 1-9-year-olds had TF during baseline mapping undertaken 4 years and 1 month previously. Every child aged 10-14 years in those villages was eligible to be examined for clinical signs of corneal pannus, Herbert's pits and conjunctival scarring. A grading system that built on existing WHO grading systems was used. RESULTS Of 1,293 resident children, 1,181 (91%) were examined. Of 1,178 with complete examination data, only one (0.08%) individual had concurrent scarring and limbal signs. CONCLUSIONS The WHO-predefined criteria for continuation of MDA were not met. Ongoing behavioural and environmental improvement aspects of the SAFE strategy may contribute to integrated NTD control. Surveillance methods should be strengthened to enable PNG health authorities to identify future changes in disease prevalence.
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Affiliation(s)
| | - Magdelene Mangot
- National Prevention of Blindness Committee, Port Moresby, Papua New Guinea
| | - Wendy Houinei
- National Department of Health, Port Moresby, Papua New Guinea
| | - Melinda Susapu
- National Department of Health, Port Moresby, Papua New Guinea
| | | | | | | | | | | | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - David Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - Ana Bakhtiari
- International Trachoma Initiative,Task Force for Global Health, Atlanta, USA
| | - Andreas Müller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Aya Yajima
- Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila, Philippines
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Robert Ko
- National Department of Health, Port Moresby, Papua New Guinea
| | - Jambi Garap
- National Prevention of Blindness Committee, Port Moresby, Papua New Guinea
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8
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Petrone S, Whiteman M, Gupta S. Azithromycin Prescriptions in Children From 2016-2018: Room for Improvement. Clin Pediatr (Phila) 2024; 63:179-182. [PMID: 37882071 DOI: 10.1177/00099228231206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
| | - Matthew Whiteman
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Shipra Gupta
- School of Medicine, West Virginia University, Morgantown, WV, USA
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9
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Sata E, Seife F, Ayele Z, Murray SA, Wickens K, Le P, Zerihun M, Melak B, Chernet A, Jensen KA, Gessese D, Zeru T, Dawed AA, Debebe H, Tadesse Z, Callahan EK, Martin DL, Nash SD. Wait and watch: A trachoma surveillance strategy from Amhara region, Ethiopia. PLoS Negl Trop Dis 2024; 18:e0011986. [PMID: 38386689 PMCID: PMC10914254 DOI: 10.1371/journal.pntd.0011986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/05/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Trachoma recrudescence after elimination as a public health problem has been reached is a concern for control programs globally. Programs typically conduct district-level trachoma surveillance surveys (TSS) ≥ 2 years after the elimination threshold is achieved to determine whether the prevalence of trachomatous inflammation-follicular (TF) among children ages 1 to 9 years remains <5%. Many TSS are resulting in a TF prevalence ≥5%. Once a district returns to TF ≥5%, a program typically restarts costly mass drug administration (MDA) campaigns and surveys at least twice, for impact and another TSS. In Amhara, Ethiopia, most TSS which result in a TF ≥5% have a prevalence close to 5%, making it difficult to determine whether the result is due to true recrudescence or to statistical variability. This study's aim was to monitor recrudescence within Amhara by waiting to restart MDA within 2 districts with a TF prevalence ≥5% at TSS, Metema = 5.2% and Woreta Town = 5.1%. The districts were resurveyed 1 year later using traditional and alternative indicators, such as measures of infection and serology, a "wait and watch" approach. METHODS/PRINCIPAL FINDINGS These post-surveillance surveys, conducted in 2021, were multi-stage cluster surveys whereby certified graders assessed trachoma signs. Children ages 1 to 9 years provided a dried blood spot and children ages 1 to 5 years provided a conjunctival swab. TF prevalence in Metema and Woreta Town were 3.6% (95% Confidence Interval [CI]:1.4-6.4) and 2.5% (95% CI:0.8-4.5) respectively. Infection prevalence was 1.2% in Woreta Town and 0% in Metema. Seroconversion rates to Pgp3 in Metema and Woreta Town were 0.4 (95% CI:0.2-0.7) seroconversions per 100 child-years and 0.9 (95% CI:0.6-1.5) respectively. CONCLUSIONS/SIGNIFICANCE Both study districts had a TF prevalence <5% with low levels of Chlamydia trachomatis infection and transmission, and thus MDA interventions are no longer warranted. The wait and watch approach represents a surveillance strategy which could lead to fewer MDA campaigns and surveys and thus cost savings with reduced antibiotic usage.
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Affiliation(s)
- Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Fikre Seife
- Disease Prevention and Control Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Sarah A. Murray
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Karana Wickens
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Internships and Fellowships, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Phong Le
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Kimberly A. Jensen
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Taye Zeru
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Adisu Abebe Dawed
- Department of Health Promotion and Disease Prevention, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Hiwot Debebe
- Department of Health Promotion and Disease Prevention, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
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10
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Paul D, Chawla M, Ahrodia T, Narendrakumar L, Das B. Antibiotic Potentiation as a Promising Strategy to Combat Macrolide Resistance in Bacterial Pathogens. Antibiotics (Basel) 2023; 12:1715. [PMID: 38136749 PMCID: PMC10740890 DOI: 10.3390/antibiotics12121715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Antibiotics, which hit the market with astounding impact, were once called miracle drugs, as these were considered the ultimate cure for infectious diseases in the mid-20th century. However, today, nearly all bacteria that afflict humankind have become resistant to these wonder drugs once developed to stop them, imperiling the foundation of modern medicine. During the COVID-19 pandemic, there was a surge in macrolide use to treat secondary infections and this persistent use of macrolide antibiotics has provoked the emergence of macrolide resistance. In view of the current dearth of new antibiotics in the pipeline, it is essential to find an alternative way to combat drug resistance. Antibiotic potentiators or adjuvants are non-antibacterial active molecules that, when combined with antibiotics, increase their activity. Thus, potentiating the existing antibiotics is one of the promising approaches to tackle and minimize the impact of antimicrobial resistance (AMR). Several natural and synthetic compounds have demonstrated effectiveness in potentiating macrolide antibiotics against multidrug-resistant (MDR) pathogens. The present review summarizes the different resistance mechanisms adapted by bacteria to resist macrolides and further emphasizes the major macrolide potentiators identified which could serve to revive the antibiotic and can be used for the reversal of macrolide resistance.
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Affiliation(s)
- Deepjyoti Paul
- Functional Genomics Laboratory, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, Faridabad 121001, India
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11
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Smit CCH, Lambert M, Rogers K, Djordjevic SP, Van Oijen AM, Keighley C, Taxis K, Robertson H, Pont LG. One Health Determinants of Escherichia coli Antimicrobial Resistance in Humans in the Community: An Umbrella Review. Int J Mol Sci 2023; 24:17204. [PMID: 38139033 PMCID: PMC10743193 DOI: 10.3390/ijms242417204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
To date, the scientific literature on health variables for Escherichia coli antimicrobial resistance (AMR) has been investigated throughout several systematic reviews, often with a focus on only one aspect of the One Health variables: human, animal, or environment. The aim of this umbrella review is to conduct a systematic synthesis of existing evidence on Escherichia coli AMR in humans in the community from a One Health perspective. PubMed, EMBASE, and CINAHL were searched on "antibiotic resistance" and "systematic review" from inception until 25 March 2022 (PROSPERO: CRD42022316431). The methodological quality was assessed, and the importance of identified variables was tabulated across all included reviews. Twenty-three reviews were included in this study, covering 860 primary studies. All reviews were of (critically) low quality. Most reviews focused on humans (20), 3 on animals, and 1 on both human and environmental variables. Antibiotic use, urinary tract infections, diabetes, and international travel were identified as the most important human variables. Poultry farms and swimming in freshwater were identified as potential sources for AMR transmission from the animal and environmental perspectives. This umbrella review highlights a gap in high-quality literature investigating the time between variable exposure, AMR testing, and animal and environmental AMR variables.
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Affiliation(s)
- Chloé C. H. Smit
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2008, Australia; (C.C.H.S.); (K.R.)
| | - Maarten Lambert
- Department of PharmacoTherapy, -Epidemiology and -Economics, Faculty of Science and Engineering, University of Groningen, 9713 AV Groningen, The Netherlands; (M.L.); (K.T.)
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2008, Australia; (C.C.H.S.); (K.R.)
| | - Steven P. Djordjevic
- The Australian Institute for Microbiology & Infection, University of Technology Sydney, Sydney, NSW 2007, Australia;
| | - Antoine M. Van Oijen
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia;
| | - Caitlin Keighley
- Southern.IML Pathology, Sonic Healthcare, 3 Bridge St, Wollongong, NSW 2500, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology and -Economics, Faculty of Science and Engineering, University of Groningen, 9713 AV Groningen, The Netherlands; (M.L.); (K.T.)
| | - Hamish Robertson
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia;
| | - Lisa G. Pont
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2008, Australia; (C.C.H.S.); (K.R.)
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12
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Garde A. Cochrane corner: Macrolides versus placebo for chronic asthma. Clin Exp Allergy 2023; 53:794-797. [PMID: 37248677 DOI: 10.1111/cea.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Alison Garde
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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13
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de Campos LJ, Seleem MA, Feng J, Pires de Oliveira KM, de Andrade Dos Santos JV, Hayer S, Clayton JB, Kathi S, Fisher DJ, Ouellette SP, Conda-Sheridan M. Design, Biological Evaluation, and Computer-Aided Analysis of Dihydrothiazepines as Selective Antichlamydial Agents. J Med Chem 2023; 66:2116-2142. [PMID: 36696579 PMCID: PMC10056257 DOI: 10.1021/acs.jmedchem.2c01894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Chlamydia trachomatis (CT) causes the most prevalent sexually transmitted bacterial disease in the United States. The lack of drug selectivity is one of the main challenges of the current antichlamydial pharmacotherapy. The metabolic needs of CT are controlled, among others, by cylindrical proteases and their chaperones (e.g., ClpX). It has been shown that dihydrothiazepines can disrupt CT-ClpXP. Based on this precedent, we synthesized a dihydrothiazepine library and characterized its antichlamydial activity using a modified semi-high-throughput screening assay. Then, we demonstrated their ability to inhibit ClpX ATPase activity in vitro, supporting ClpX as a target. Further, our lead compound displayed a promising selectivity profile against CT, acceptable cytotoxicity, no mutagenic potential, and good in vitro stability. A two-dimensional quantitative structure-activity relationship (2D QSAR) model was generated as a support tool in the identification of more potent antichlamydial molecules. This study suggests dihydrothiazepines are a promising starting point for the development of new and selective antichlamydial drugs.
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Affiliation(s)
- Luana Janaína de Campos
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Mohamed A Seleem
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Jiachen Feng
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Kelly Mari Pires de Oliveira
- Faculty of Biological and Environmental Science, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil
| | | | - Shivdeep Hayer
- Department of Biology, University of Nebraska at Omaha, Omaha, Nebraska 68182, United States
| | - Jonathan B Clayton
- Department of Biology, University of Nebraska at Omaha, Omaha, Nebraska 68182, United States
- Department of Food Science and Technology, University of Nebraska─Lincoln, Lincoln, Nebraska 68588, United States
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
- Nebraska Food for Health Center, University of Nebraska─Lincoln, Lincoln, Nebraska 68508, United States
| | - Sharvath Kathi
- School of Biological Sciences, Southern Illinois University, Carbondale, Illinois 62901, United States
| | - Derek J Fisher
- School of Biological Sciences, Southern Illinois University, Carbondale, Illinois 62901, United States
| | - Scot P Ouellette
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Martin Conda-Sheridan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
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14
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Sanders AM, Makoy S, Deathe AR, Ohidor S, Jesudason TC, Nute AW, Odongi P, Boniface L, Abuba S, Delahaut AS, Sebit W, Niquette J, Callahan EK, Walker DG, Nash SD. Cost and community acceptability of enhanced antibiotic distribution approaches for trachoma in the Republic of South Sudan: enhancing the A in SAFE (ETAS) study protocol. BMC Ophthalmol 2023; 23:51. [PMID: 36747194 PMCID: PMC9900535 DOI: 10.1186/s12886-023-02783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan. METHODS The Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey. DISCUSSION ETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study's results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030. TRIAL REGISTRATION This trial was registered on December 1st, 2022 (clinicaltrails.org: NCT05634759).
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Affiliation(s)
| | - Samuel Makoy
- Ministry of Health, Juba, Republic of South Sudan
| | - Andrew R. Deathe
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | | | | | - Andrew W. Nute
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | | | | | - Stella Abuba
- The Carter Center, Juba, Republic of South Sudan
| | | | - Wilson Sebit
- Ministry of Health, Juba, Republic of South Sudan
| | | | | | | | - Scott D. Nash
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
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15
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Adubra L, Alber D, Ashorn P, Ashorn U, Cheung YB, Cloutman-Green E, Diallo F, Ducker C, Elovainio R, Fan YM, Gates L, Gruffudd G, Haapaniemi T, Haidara F, Hallamaa L, Ihamuotila R, Klein N, Luoma J, Martell O, Sow S, Vehmasto T. Testing the effects of mass drug administration of azithromycin on mortality and other outcomes among 1-11-month-old infants in Mali (LAKANA): study protocol for a cluster-randomized, placebo-controlled, double-blinded, parallel-group, three-arm clinical trial. Trials 2023; 24:5. [PMID: 36597115 PMCID: PMC9809521 DOI: 10.1186/s13063-022-06966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Mass drug administration (MDA) of azithromycin (AZI) has been shown to reduce under-5 mortality in some but not all sub-Saharan African settings. A large-scale cluster-randomized trial conducted in Malawi, Niger, and Tanzania suggested that the effect differs by country, may be stronger in infants, and may be concentrated within the first 3 months after treatment. Another study found no effect when azithromycin was given concomitantly with seasonal malaria chemoprevention (SMC). Given the observed heterogeneity and possible effect modification by other co-interventions, further trials are needed to determine the efficacy in additional settings and to determine the most effective treatment regimen. METHODS LAKANA stands for Large-scale Assessment of the Key health-promoting Activities of two New mass drug administration regimens with Azithromycin. The LAKANA trial is designed to address the mortality and health impacts of 4 or 2 annual rounds of azithromycin MDA delivered to 1-11-month-old (29-364 days) infants, in a high-mortality and malaria holoendemic Malian setting where there is a national SMC program. Participating villages (clusters) are randomly allocated in a ratio of 3:2:4 to three groups: placebo (control):4-dose AZI:2-dose AZI. The primary outcome measured is mortality. Antimicrobial resistance (AMR) will be monitored closely before, during, and after the intervention and both among those receiving and those not receiving MDA with the study drugs. Other outcomes, from a subset of villages, comprise efficacy outcomes related to morbidity, growth and nutritional status, outcomes related to the mechanism of azithromycin activity through measures of malaria parasitemia and inflammation, safety outcomes (AMR, adverse and serious adverse events), and outcomes related to the implementation of the intervention documenting feasibility, acceptability, and economic aspects. The enrolment commenced in October 2020 and is planned to be completed by the end of 2022. The expected date of study completion is December 2024. DISCUSSION If LAKANA provides evidence in support of a positive mortality benefit resulting from azithromycin MDA, it will significantly contribute to the options for successfully promoting child survival in Mali, and elsewhere in sub-Saharan Africa. TRIAL REGISTRATION ClinicalTrials.gov NCT04424511. Registered on 11 June 2020.
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Affiliation(s)
- Laura Adubra
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Dagmar Alber
- grid.83440.3b0000000121901201Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Per Ashorn
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yin Bun Cheung
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.428397.30000 0004 0385 0924Program in Health Services and Systems Research and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Elaine Cloutman-Green
- grid.83440.3b0000000121901201Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | | | - Riku Elovainio
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yue-Mei Fan
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lily Gates
- grid.83440.3b0000000121901201Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Tiia Haapaniemi
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Lotta Hallamaa
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Rikhard Ihamuotila
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Nigel Klein
- grid.83440.3b0000000121901201Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Juho Luoma
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Samba Sow
- Center for Vaccine Development, Bamako, Mali
| | - Taru Vehmasto
- grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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16
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O'Brien KS, Arzika AM, Maliki R, Amza A, Manzo F, Mankara AK, Lebas E, Cook C, Oldenburg CE, Porco TC, Arnold BF, Bertozzi S, Keenan JD, Lietman TM. Azithromycin distribution and childhood mortality in compliance-related subgroups in Niger: complier average causal effect and spillovers in a cluster-randomized, placebo-controlled trial. Int J Epidemiol 2022; 51:1775-1784. [PMID: 34508582 DOI: 10.1093/ije/dyab198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Biannual azithromycin distribution to children 1-59 months old reduced all-cause mortality by 18% [incidence rate ratio (IRR) 0.82, 95% confidence interval (CI): 0.74, 0.90] in an intention-to-treat analysis of a randomized controlled trial in Niger. Estimation of the effect in compliance-related subgroups can support decision making around implementation of this intervention in programmatic settings. METHODS The cluster-randomized, placebo-controlled design of the original trial enabled unbiased estimation of the effect of azithromycin on mortality rates in two subgroups: (i) treated children (complier average causal effect analysis); and (ii) untreated children (spillover effect analysis), using negative binomial regression. RESULTS In Niger, 594 eligible communities were randomized to biannual azithromycin or placebo distribution and were followed from December 2014 to August 2017, with a mean treatment coverage of 90% [standard deviation (SD) 10%] in both arms. Subgroup analyses included 2581 deaths among treated children and 245 deaths among untreated children. Among treated children, the incidence rate ratio comparing mortality in azithromycin communities to placebo communities was 0.80 (95% CI: 0.72, 0.88), with mortality rates (deaths per 1000 person-years at risk) of 16.6 in azithromycin communities and 20.9 in placebo communities. Among untreated children, the incidence rate ratio was 0.91 (95% CI: 0.69, 1.21), with rates of 33.6 in azithromycin communities and 34.4 in placebo communities. CONCLUSIONS As expected, this analysis suggested similar efficacy among treated children compared with the intention-to-treat analysis. Though the results were consistent with a small spillover benefit to untreated children, this trial was underpowered to detect spillovers.
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Affiliation(s)
- Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | | | | | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
| | | | | | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Catherine Cook
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Stefano Bertozzi
- School of Public Health, University of California, Berkeley, CA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Instituto Nacional de Salud Pública, Cuernavaca, MOR, México
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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17
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Hume-Nixon M, Ratu T, Clark S, Nguyen CD, Neal EFG, Pell CL, Bright K, Watts E, Hart J, Mulholland K, Fong J, Rafai E, Sakumeni K, Tuibeqa I, Satzke C, Steer A, Russell FM. Prevention of young infant infections using oral azithromycin in labour in Fiji (Bulabula MaPei): study protocol of a randomised control trial. BMJ Open 2022; 12:e061157. [PMID: 36456016 PMCID: PMC9716885 DOI: 10.1136/bmjopen-2022-061157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Infections are a leading cause of neonatal mortality globally and can be transmitted from mother-to-child vertically or horizontally. Fiji has higher rates of serious neonatal infections and infant skin and soft tissue infections (SSTIs) than high-income countries. Research from the Gambia found that a single dose of oral azithromycin in labour decreased bacterial carriage and infections in mothers and infants, particularly infant skin infections. The Bulabula MaPei clinical trial evaluates the safety and efficacy of a single dose of azithromycin in labour in reducing the incidence of maternal and infant SSTIs and other infections and the impact on bacterial carriage. It will also describe the effect of azithromycin on antimicrobial (AMR) resistance, the maternal and infant microbiome, and infant dysbiosis. METHODS AND ANALYSIS We are conducting a blinded, placebo-controlled randomised clinical trial administering 2 g of oral azithromycin, or placebo, given to healthy, pregnant women (≥18 years) in labour in Suva, Fiji. The primary outcome is the cumulative incidence of SSTIs in infants by 3 months of age. Secondary outcomes include the incidence of other infant and maternal infections, and safety and tolerability of azithromycin in mother and infant. Following informed consent, 2110 pregnant women will be randomised in a 1:1 ratio, with all study staff and participants masked to group allocation. Mother/infant pairs will be followed up for 12 months over six visits collecting clinical data on infections, antimicrobial use, safety and anthropometrics, in addition to nasopharyngeal, oropharyngeal, rectovaginal and vaginal swabs, maternal breastmilk and infant stool samples, in order to compare bacterial carriage, AMR rates and microbiome. Recruitment for Bulabula MaPei started in June 2019. ETHICS AND DISSEMINATION This trial was approved and is being conducted according to the protocol approved by The Royal Children's Hospital Human Research Ethics Committee, Australia, and the Fiji National Health Research and Ethics Review Committee. The findings of this study will be disseminated in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT03925480.
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Affiliation(s)
- Maeve Hume-Nixon
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Tupou Ratu
- Asia-Pacific Health, Murdoch Children's Research Institute, Suva, Fiji
| | - Stephanie Clark
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Cattram Duong Nguyen
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Eleanor F G Neal
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Casey L Pell
- Translational Microbiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kathryn Bright
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Emma Watts
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John Hart
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Mulholland
- New Vaccines, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - James Fong
- Ministry of Health and Medical Services, Suva, Fiji
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Ilisapeci Tuibeqa
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Catherine Satzke
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Translational Microbiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Steer
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fiona M Russell
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Asia-Pacific Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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18
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Hou C, Jin Y, Wu H, Li P, Liu L, Zheng K, Wang C. Alternative strategies for Chlamydia treatment: Promising non-antibiotic approaches. Front Microbiol 2022; 13:987662. [PMID: 36504792 PMCID: PMC9727249 DOI: 10.3389/fmicb.2022.987662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Chlamydia is an obligate intracellular bacterium where most species are pathogenic and infectious, causing various infectious diseases and complications in humans and animals. Antibiotics are often recommended for the clinical treatment of chlamydial infections. However, extensive research has shown that antibiotics may not be sufficient to eliminate or inhibit infection entirely and have some potential risks, including antibiotic resistance. The impact of chlamydial infection and antibiotic misuse should not be underestimated in public health. This study explores the possibility of new therapeutic techniques, including a review of recent studies on preventing and suppressing chlamydial infection by non-antibiotic compounds.
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Affiliation(s)
- Chen Hou
- School of Basic Medicine, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Yingqi Jin
- School of Basic Medicine, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Hua Wu
- Department of Clinical Laboratory, Affiliated Hengyang Hospital of Southern Medical University, Hengyang Central Hospital, Hengyang, China
| | - Pengyi Li
- School of Basic Medicine, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Longyun Liu
- School of Basic Medicine, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Kang Zheng
- Department of Clinical Laboratory, Affiliated Hengyang Hospital of Southern Medical University, Hengyang Central Hospital, Hengyang, China,*Correspondence: Kang Zheng
| | - Chuan Wang
- School of Basic Medicine, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China,Chuan Wang
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19
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Adams J, Kim SH, Solomon AW. Where should we offer mass drug administration for trachoma? Med J Aust 2022; 217:522-523. [DOI: 10.5694/mja2.51752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
| | - Sung Hye Kim
- World Health Organization Regional Office for the Western Pacific Manila Philippines
- Hanyang University Seoul Republic of Korea
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20
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Pickering H, Ramadhani AM, Massae P, Mafuru E, Malisa A, Mbuya K, Makupa W, Mtuy T, Derrick T, Houghton J, Bailey RL, Mabey DCW, Burton MJ, Holland MJ. The conjunctival microbiome before and after azithromycin mass drug administration for trachoma control in a cohort of Tanzanian children. Front Public Health 2022; 10:1015714. [PMID: 36324475 PMCID: PMC9619060 DOI: 10.3389/fpubh.2022.1015714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Abstract
Background Trachoma, caused by ocular infection with Chlamydia trachomatis, is a neglected tropical disease that can lead to blinding pathology. Current trachoma control programmes have successfully used mass drug administration (MDA) with azithromycin to clear C. trachomatis infection and reduce transmission, alongside promoting facial cleanliness for better personal hygiene and environmental improvement. In areas of low-trachoma endemicity, the relationship between C. trachomatis infection and trachomatous disease weakens, and non-chlamydial bacteria have been associated with disease signs. Methods We enrolled a cohort of children aged 6-10 years from three adjacent trachoma endemic villages in Kilimanjaro and Arusha regions, Northern Tanzania. Children were divided into four clinical groups based on the presence or absence of ocular C. trachomatis infection and clinical signs of trachomatous papillary inflammation (TP). To determine the impact of treatment on the ocular microbiome in these clinical groups, we performed V4-16S rRNA sequencing of conjunctival DNA from children 3-9 months pre-MDA (n = 269) and 3 months post-MDA (n = 79). Results Chlamydia trachomatis PCR-negative, no TP children had the highest pre-MDA ocular microbiome alpha diversity, which was reduced in C. trachomatis infected children and further decreased in those with TP. Pre-MDA, Haemophilus and Staphylococcus were associated with C. trachomatis infection with and without concurrent TP, while Helicobacter was increased in those with TP in the absence of current C. trachomatis infection. Post-MDA, none of the studied children had ocular C. trachomatis infection or TP. MDA increased ocular microbiome diversity in all clinical groups, the change was of greater magnitude in children with pre-MDA TP. MDA effectively reduced the prevalence of disease causing pathogenic non-chlamydial bacteria, and promoted restoration of a normal, healthy conjunctival microbiome. Conclusion We identified Helicobacter as a non-chlamydial bacterium associated with the clinical signs of TP. Further investigation to determine its relevance in other low-endemicity communities is required. MDA was shown to be effective at clearing C. trachomatis infection and other non-chlamydial ocular pathogens, without any detrimental longitudinal effects on the ocular microbiome. These findings suggest that azithromycin MDA may be valuable in trachoma control even in populations where the relationship between clinical signs of trachoma and the prevalence of current ocular C. trachomatis infection has become dissociated.
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Affiliation(s)
- Harry Pickering
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom,*Correspondence: Harry Pickering
| | | | | | - Elias Mafuru
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Aiweda Malisa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kelvin Mbuya
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Tara Mtuy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tamsyn Derrick
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joanna Houghton
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom,National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Martin J. Holland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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21
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Li J, Xiong T, Yue Y, Choonara I, Qazi S, Tang J, Shi J, Wang H, Qu Y, Mu D. Secondary Effects from Mass Azithromycin Administration: A Systematic Review and Meta-analysis. Am J Trop Med Hyg 2022; 107:904-911. [PMID: 35970284 PMCID: PMC9651525 DOI: 10.4269/ajtmh.22-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/23/2022] [Indexed: 11/07/2022] Open
Abstract
The effects of azithromycin mass drug administration (MDA) on trachoma and yaws have been addressed. However, the secondary effects of azithromycin MDA remain unclear. This study aimed to explore the secondary effects of azithromycin MDA. PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from conception to January 5, 2022. Studies on secondary effects of azithromycin MDA were included. A total of 34 studies were included. Six of them reported on child mortality, 10 on malaria, and 20 on general morbidity and condition. Azithromycin MDA reduced child mortality, and quarterly MDA may be most beneficial for reducing child mortality. The effect of azithromycin MDA on malaria was weak. No association was observed between azithromycin MDA and malaria parasitemia (rate ratio: 0.71, 95% confidence interval: 0.43-1.15). Azithromycin MDA was associated with a lower risk of respiratory tract infections and diarrhea. Additionally, it was associated with a lower risk of fever, vomiting, and headache. The carriage of pathogenic organisms such as Streptococcus pneumoniae and gut Campylobacter species was reduced. However, these secondary effects of azithromycin MDA appeared to last only a few weeks. Moreover, no association was observed between azithromycin MDA and nutritional improvement in children. In conclusion, azithromycin MDA had favorable secondary effects on child mortality and morbidity. However, the effects were short term.
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Affiliation(s)
- Jinhui Li
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Xiong
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Yue
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children’s Hospital, Derby, United Kingdom
| | - Shamim Qazi
- World Health Organization, Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Jun Tang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua Wang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Qu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pharmacy, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, Sichuan, China
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22
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Doan T, Gebre T, Ayele B, Zerihun M, Hinterwirth A, Zhong L, Chen C, Ruder K, Zhou Z, Emerson PM, Porco TC, Keenan JD, Lietman TM. Effect of Azithromycin on the Ocular Surface Microbiome of Children in a High Prevalence Trachoma Area. Cornea 2022; 41:1260-1264. [PMID: 34483276 PMCID: PMC8894504 DOI: 10.1097/ico.0000000000002863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of the 4 times per year mass azithromycin distributions on the ocular surface microbiome of children in a trachoma endemic area. METHODS In this cluster-randomized controlled trial, children aged 1 to 10 years in rural communities in the Goncha Seso Enesie district of Ethiopia were randomized to either no treatment or treatment with a single dose of oral azithromycin (height-based dosing to approximate 20 mg/kg) every 3 months for 1 year. Post hoc analysis of ocular surface Chlamydia trachomatis load, microbial community diversity, and macrolide resistance determinants was performed to evaluate differences between treatment arms. RESULTS One thousand two hundred fifty-five children from 24 communities were included in the study. The mean azithromycin coverage in the treated communities was 80% (95% CI: 73%-86%). The average age was 5 years (95% CI: 4-5). Ocular surface C. trachomatis load was reduced in children treated with the 4 times per year azithromycin ( P = 0.0003). Neisseria gonorrhoeae , Neisseria lactamica , and Neisseria meningitidis were more abundant in the no-treatment arm compared with the treated arm. The macrolide resistance gene ermB was not different between arms ( P = 0.63), but mefA / E was increased ( P = 0.04) in the azithromycin-treated arm. CONCLUSIONS We found a reduction in the load of C. trachomatis and 3 Neisseria species in communities treated with azithromycin. These benefits came at the cost of selection for macrolide resistance.
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Affiliation(s)
- Thuy Doan
- Francis I Proctor Foundation, University of California San Francisco, USA
- Department of Ophthalmology, University of California San Francisco, USA
| | | | - Berhan Ayele
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | - Armin Hinterwirth
- Francis I Proctor Foundation, University of California San Francisco, USA
| | - Lina Zhong
- Francis I Proctor Foundation, University of California San Francisco, USA
| | - Cindi Chen
- Francis I Proctor Foundation, University of California San Francisco, USA
| | - Kevin Ruder
- Francis I Proctor Foundation, University of California San Francisco, USA
| | - Zhaoxia Zhou
- Francis I Proctor Foundation, University of California San Francisco, USA
| | - Paul M. Emerson
- International Trachoma Initiative, Addis Ababa, Ethiopia
- International Trachoma Initiative, Atlanta, Georgia, USA
| | - Travis C. Porco
- Francis I Proctor Foundation, University of California San Francisco, USA
- Department of Ophthalmology, University of California San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Jeremy D. Keenan
- Francis I Proctor Foundation, University of California San Francisco, USA
- Department of Ophthalmology, University of California San Francisco, USA
| | - Thomas M. Lietman
- Francis I Proctor Foundation, University of California San Francisco, USA
- Department of Ophthalmology, University of California San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
- Institute for Global Health Sciences, University of California San Francisco, USA
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23
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Yu X, Xu Q, Chen W, Mai Z, Mo L, Su X, Ou J, Lan Y, Zheng H, Xue Y. Rhein inhibits Chlamydia trachomatis infection by regulating pathogen-host cell. Front Public Health 2022; 10:1002029. [PMID: 36238249 PMCID: PMC9552556 DOI: 10.3389/fpubh.2022.1002029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023] Open
Abstract
The global incidence of genital Chlamydia trachomatis infection increased rapidly as the primary available treatment of C. trachomatis infection being the use of antibiotics. However, the development of antibiotics resistant stain and other treatment failures are often observed in patients. Consequently, novel therapeutics are urgently required. Rhein is a monomer derivative of anthraquinone compounds with an anti-infection activity. This study investigated the effects of rhein on treating C. trachomatis infection. Rhein showed significant inhibitory effects on the growth of C. trachomatis in multiple serovars of C. trachomatis, including D, E, F and L1, and in various host cells, including HeLa, McCoy and Vero. Rhein could not directly inactivate C. trachomatis but could inhibit the growth of C. trachomatis by regulating pathogen-host cell interactions. Combined with azithromycin, the inhibitory effect of rehin was synergistic both in vitro and in vivo. Together these findings suggest that rhein could be developed for the treatment of C. trachomatis infections.
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Affiliation(s)
- Xueying Yu
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China,Department of Clinical Laboratory, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Qingqing Xu
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wentao Chen
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China,Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China
| | - Zhida Mai
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Lijun Mo
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xin Su
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jiangli Ou
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yinyuan Lan
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Heping Zheng
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China,Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China,*Correspondence: Heping Zheng
| | - Yaohua Xue
- Department of Clinical Laboratory, Dermatology Hospital, Southern Medical University, Guangzhou, China,Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China,Yaohua Xue
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24
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Rogawski McQuade ET, Brennhofer SA, Elwood SE, McMurry TL, Lewnard JA, Mduma ER, Shrestha S, Iqbal N, Bessong PO, Kang G, Kosek M, Lima AAM, Ahmed T, Liu J, Houpt ER, Platts-Mills JA. Frequency of bystander exposure to antibiotics for enteropathogenic bacteria among young children in low-resource settings. Proc Natl Acad Sci U S A 2022; 119:e2208972119. [PMID: 36037372 PMCID: PMC9457395 DOI: 10.1073/pnas.2208972119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Children in low-resource settings carry enteric pathogens asymptomatically and are frequently treated with antibiotics, resulting in opportunities for pathogens to be exposed to antibiotics when not the target of treatment (i.e., bystander exposure). We quantified the frequency of bystander antibiotic exposures for enteric pathogens and estimated associations with resistance among children in eight low-resource settings. We analyzed 15,697 antibiotic courses from 1,715 children aged 0 to 2 y from the MAL-ED birth cohort. We calculated the incidence of bystander exposures and attributed exposures to respiratory and diarrheal illnesses. We associated bystander exposure with phenotypic susceptibility of E. coli isolates in the 30 d following exposure and at the level of the study site. There were 744.1 subclinical pathogen exposures to antibiotics per 100 child-years. Enteroaggregative Escherichia coli was the most frequently exposed pathogen, with 229.6 exposures per 100 child-years. Almost all antibiotic exposures for Campylobacter (98.8%), enterotoxigenic E. coli (95.6%), and typical enteropathogenic E. coli (99.4%), and the majority for Shigella (77.6%), occurred when the pathogens were not the target of treatment. Respiratory infections accounted for half (49.9%) and diarrheal illnesses accounted for one-fourth (24.6%) of subclinical enteric bacteria exposures to antibiotics. Bystander exposure of E. coli to class-specific antibiotics was associated with the prevalence of phenotypic resistance at the community level. Antimicrobial stewardship and illness-prevention interventions among children in low-resource settings would have a large ancillary benefit of reducing bystander selection that may contribute to antimicrobial resistance.
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Affiliation(s)
| | - Stephanie A. Brennhofer
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
| | - Sarah E. Elwood
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
| | - Timothy L. McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22908
| | - Joseph A. Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720
| | - Estomih R. Mduma
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Sanjaya Shrestha
- Walter Reed/AFRIMS Research Unit, Nepal, Kathmandu, 44600, Nepal
| | | | - Pascal O. Bessong
- University of Venda, Thohoyandou, 0950, South Africa
- Center for Global Health Equity, University of Virginia, Charlottesville, VA 22908
| | | | - Margaret Kosek
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
- Asociación Benéfica PRISMA, Iquitos, 15088, Peru
| | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, 1212, Bangladesh
| | - Jie Liu
- School of Public Health, Qingdao University, Qingdao, Shandong, 266071, China
| | - Eric R. Houpt
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
| | - James A. Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
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25
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Coulibaly B, Kiemde D, Zonou G, Sié A, Dah C, Bountogo M, Brogdon J, Hu H, Lebas E, Porco TC, Doan T, Lietman TM, Oldenburg CE. Effect of Single-dose Azithromycin on Pneumococcal Carriage and Resistance: A Randomized Controlled Trial. Pediatr Infect Dis J 2022; 41:728-730. [PMID: 35944061 PMCID: PMC9359759 DOI: 10.1097/inf.0000000000003585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
We evaluated antibiotic resistance selection in Streptococcus pneumoniae isolates from children participating in an individually randomized trial of single-dose azithromycin versus placebo. After 14 days, the prevalence of resistance to erythromycin, oxacillin, and clindamycin was elevated in the azithromycin versus placebo group. There was no difference at 6 months.
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Affiliation(s)
| | - Dramane Kiemde
- From the Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Guillaume Zonou
- From the Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sié
- From the Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Clarisse Dah
- From the Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Mamadou Bountogo
- From the Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, San Francisco, CA
| | - Huiyu Hu
- Francis I Proctor Foundation, University of California, San Francisco, CA
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, CA
| | - Travis C. Porco
- Francis I Proctor Foundation, University of California, San Francisco, CA
| | - Thuy Doan
- Francis I Proctor Foundation, University of California, San Francisco, CA
| | - Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco, CA
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
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Konopka JK, Chatterjee P, LaMontagne C, Brown J. Environmental impacts of mass drug administration programs: exposures, risks, and mitigation of antimicrobial resistance. Infect Dis Poverty 2022; 11:78. [PMID: 35773680 PMCID: PMC9243877 DOI: 10.1186/s40249-022-01000-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/09/2022] [Indexed: 01/05/2023] Open
Abstract
Mass drug administration (MDA) of antimicrobials has shown promise in the reduction and potential elimination of a variety of neglected tropical diseases (NTDs). However, with antimicrobial resistance (AMR) becoming a global crisis, the risks posed by widespread antimicrobial use need to be evaluated. As the role of the environment in AMR emergence and dissemination has become increasingly recognized, it is likewise crucial to establish the role of MDA in environmental AMR pollution, along with the potential impacts of such pollution. This review presents the current state of knowledge on the antimicrobial compounds, resistant organisms, and antimicrobial resistance genes in MDA trials, routes of these determinants into the environment, and their persistence and ecological impacts, particularly in low and middle-income countries where these trials are most common. From the few studies directly evaluating AMR outcomes in azithromycin MDA trials, it is becoming apparent that MDA efforts can increase carriage and excretion of resistant pathogens in a lasting way. However, research on these outcomes for other antimicrobials used in MDA trials is sorely needed. Furthermore, while paths of AMR determinants from human waste to the environment and their persistence thereafter are supported by the literature, quantitative information on the scope and likelihood of this is largely absent. We recommend some mitigative approaches that would be valuable to consider in future MDA efforts. This review stands to be a valuable resource for researchers and policymakers seeking to evaluate the impacts of MDA.
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Affiliation(s)
- Joanna K Konopka
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Pranab Chatterjee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Connor LaMontagne
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7431, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7431, USA
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Olesen SW. Uses of mathematical modeling to estimate the impact of mass drug administration of antibiotics on antimicrobial resistance within and between communities. Infect Dis Poverty 2022; 11:75. [PMID: 35773748 PMCID: PMC9245243 DOI: 10.1186/s40249-022-00997-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Antibiotics are a key part of modern healthcare, but their use has downsides, including selecting for antibiotic resistance, both in the individuals treated with antibiotics and in the community at large. When evaluating the benefits and costs of mass administration of azithromycin to reduce childhood mortality, effects of antibiotic use on antibiotic resistance are important but difficult to measure, especially when evaluating resistance that “spills over” from antibiotic-treated individuals to other members of their community. The aim of this scoping review was to identify how the existing literature on antibiotic resistance modeling could be better leveraged to understand the effect of mass drug administration (MDA) on antibiotic resistance. Main text Mathematical models of antibiotic use and resistance may be useful for estimating the expected effects of different MDA implementations on different populations, as well as aiding interpretation of existing data and guiding future experimental design. Here, strengths and limitations of models of antibiotic resistance are reviewed, and possible applications of those models in the context of mass drug administration with azithromycin are discussed. Conclusions Statistical models of antibiotic use and resistance may provide robust and relevant estimates of the possible effects of MDA on resistance. Mechanistic models of resistance, while able to more precisely estimate the effects of different implementations of MDA on resistance, may require more data from MDA trials to be accurately parameterized. Graphical Abstract ![]()
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Affiliation(s)
- Scott W Olesen
- Department of Immunology and Infectious Diseases, Harvard Chan School, Boston, MA, USA.
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Rolfe RJ, Shaikh H, Tillekeratne LG. Mass drug administration of antibacterials: weighing the evidence regarding benefits and risks. Infect Dis Poverty 2022; 11:77. [PMID: 35773722 PMCID: PMC9243730 DOI: 10.1186/s40249-022-00998-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mass drug administration (MDA) is a strategy to improve health at the population level through widespread delivery of medicine in a community. We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials, focusing predominantly on azithromycin as it has the greatest evidence base.
Main body High-quality evidence from randomized controlled trials (RCTs) indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma. In addition, RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline. This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin, with the greatest effect observed in children < 1 year of age. In addition, observational data suggest that infections such as skin and soft tissue infections, rheumatic heart disease, acute respiratory illness, diarrheal illness, and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin. However, the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear. Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question. In addition to benefits, there are several important risks associated with MDA-azithromycin. Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects, idiopathic hypertrophic pyloric stenosis, cardiovascular side effects, and increase in chronic diseases such as asthma and obesity. Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms. Further, there is the risk for cross-resistance with other antibacterial agents, especially clindamycin. Conclusions Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma, yaws, and mortality in children < 5 years of age in certain under-resourced settings. However, there are significant potential risks that need to be considered when deciding how, when, and where to implement these programs. Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented. Graphical Abstract ![]()
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Affiliation(s)
- Robert J Rolfe
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Hassaan Shaikh
- Department of Medicine, University of Pittsburgh Medical Center, McKeesport, PA, USA
| | - L Gayani Tillekeratne
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA. .,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Chavda VP, Pandya A, Kypreos E, Patravale V, Apostolopoulos V. Chlamydia trachomatis: quest for an eye-opening vaccine breakthrough. Expert Rev Vaccines 2022; 21:771-781. [PMID: 35470769 DOI: 10.1080/14760584.2022.2061461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chlamydia trachomatis, commonly referred to as chlamydia (a bacterium), is a common sexually transmitted infection, and if attended to early, it can be treatable. However, if left untreated it can lead to serious consequences. C. trachomatis infects both females and males although its occurrence in females is more common, and it can spread to the eyes causing disease and in some case blindness. AREA COVERED With ongoing attempts in the most impoverished regions of the country, trachoma will be eradicated as a blinding disease by the year 2022. A prophylactic vaccine candidate with established safety and efficacy is a cogent tool to achieve this goal. This manuscript covers the vaccine development programs for chlamydial infection. EXPERT OPINION Currently, the Surgery Antibiotics Facial Environmental (SAFE) program is being implemented in endemic countries in order to reduce transmission and control of the disease. Vaccines have been shown over the years to protect against infectious diseases. Charge variant-based adjuvant can also be used for the successful delivery of chlamydial specific antigen for efficient vaccine delivery through nano delivery platform. Thus, a vaccine against C. trachomatis would be of great public health benefit.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad India
| | - Anjali Pandya
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai India
| | - Erica Kypreos
- Department of Immunology, Institute for Health and Sport, Victoria University, Melbourne VIC Australia
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai India
| | - Vasso Apostolopoulos
- Department of Immunology, Institute for Health and Sport, Victoria University, Melbourne VIC Australia
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Tedijanto C, Aragie S, Tadesse Z, Haile M, Zeru T, Nash SD, Wittberg DM, Gwyn S, Martin DL, Sturrock HJW, Lietman TM, Keenan JD, Arnold BF. Predicting future community-level ocular Chlamydia trachomatis infection prevalence using serological, clinical, molecular, and geospatial data. PLoS Negl Trop Dis 2022; 16:e0010273. [PMID: 35275911 PMCID: PMC8942265 DOI: 10.1371/journal.pntd.0010273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/23/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Trachoma is an infectious disease characterized by repeated exposures to Chlamydia trachomatis (Ct) that may ultimately lead to blindness. Efficient identification of communities with high infection burden could help target more intensive control efforts. We hypothesized that IgG seroprevalence in combination with geospatial layers, machine learning, and model-based geostatistics would be able to accurately predict future community-level ocular Ct infections detected by PCR. We used measurements from 40 communities in the hyperendemic Amhara region of Ethiopia to assess this hypothesis. Median Ct infection prevalence among children 0–5 years old increased from 6% at enrollment, in the context of recent mass drug administration (MDA), to 29% by month 36, following three years without MDA. At baseline, correlation between seroprevalence and Ct infection was stronger among children 0–5 years old (ρ = 0.77) than children 6–9 years old (ρ = 0.48), and stronger than the correlation between active trachoma and Ct infection (0-5y ρ = 0.56; 6-9y ρ = 0.40). Seroprevalence was the strongest concurrent predictor of infection prevalence at month 36 among children 0–5 years old (cross-validated R2 = 0.75, 95% CI: 0.58–0.85), though predictive performance declined substantially with increasing temporal lag between predictor and outcome measurements. Geospatial variables, a spatial Gaussian process, and stacked ensemble machine learning did not meaningfully improve predictions. Serological markers among children 0–5 years old may be an objective tool for identifying communities with high levels of ocular Ct infections, but accurate, future prediction in the context of changing transmission remains an open challenge.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- * E-mail:
| | | | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Scott D. Nash
- The Carter Center, Atlanta, Georgia, United States of America
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
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Seleem MA, Wood NA, Brinkworth AJ, Manam S, Carabeo RA, Murthy AK, Ouellette SP, Conda-Sheridan M. In Vitro and In Vivo Activity of (Trifluoromethyl)pyridines as Anti- Chlamydia trachomatis Agents. ACS Infect Dis 2022; 8:227-241. [PMID: 34935346 PMCID: PMC9516413 DOI: 10.1021/acsinfecdis.1c00553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chlamydia trachomatis is the leading pathogen in sexually transmitted bacterial infections across the globe. The development of a selective treatment against this pathogen could be an attractive therapeutic option that will reduce the overuse of broad-spectrum antibiotics. Previously, we reported some sulfonylpyridine-based compounds that showed selectivity against C. trachomatis. Here, we describe a set of related compounds that display enhanced anti-chlamydial potency when compared to our early leads. We found that the active molecules are bactericidal and have no impact on Staphylococcus aureus or Escherichia coli strains. Importantly, the molecules were not toxic to mammalian cells. Furthermore, a combination of molecule 20 (the most active molecule) and azithromycin at subinhibitory concentrations acted synergistically to inhibit chlamydial growth. Molecule 20 also eradicated Chlamydia in a 3D infection model and accelerated the recovery of Chlamydia-infected mice. This work presents compounds that could be further developed to be used alone or in combination with existing treatment regimens against chlamydial infections.
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Affiliation(s)
- Mohamed A. Seleem
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Nicholas A. Wood
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Amanda J. Brinkworth
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Srikanth Manam
- Department of Pathology and Population Medicine, Midwestern University, Glendale, Arizona 85308, United States
| | - Rey A. Carabeo
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Ashlesh K. Murthy
- Department of Pathology and Population Medicine, Midwestern University, Glendale, Arizona 85308, United States
| | - Scot P. Ouellette
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Martin Conda-Sheridan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
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Khan R, Gangar M, Gangar M, Motilal S. Eight years of antibiotic consumption at a primary care outpatient facility in Trinidad and Tobago 2011-18: a synopsis of consumption trends. JAC Antimicrob Resist 2021; 3:dlab162. [PMID: 34676367 PMCID: PMC8527501 DOI: 10.1093/jacamr/dlab162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore antibiotic consumption and surveillance patterns in Trinidad and Tobago. METHODS A retrospective observational study was conducted. Stock requisition and logbooks from a District Health Facility in Trinidad were examined for the period 2011-18. Daily Defined Doses (DDDs) for each antibiotic were computed and extrapolated to represent the antibiotic consumption per 1000 residents within the population. RESULTS The mean consumption across the years was 2.917 DDD per 1000 residents per day. The most consumed antibiotics were cefuroxime, amoxicillin/clavulanic acid, and azithromycin, with mean DDDs of 0.879, 0.695 and 0.373 respectively. The least consumed antibiotics were cefaclor and clarithromycin, with DDDs of 0.0006 and 0.0005, respectively. CONCLUSIONS Trinidad and Tobago is not mentioned in the WHO surveillance report on antibiotic consumption. Our most recent (2018) estimate of total antibiotic consumption was 3.224 DDD per 1000 habitants per day. This figure is an underestimate, as data was derived solely from the public sector. Notwithstanding, this data is novel and can provide a baseline for future comparison and development of national surveillance programmes.
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Affiliation(s)
- Raveed Khan
- Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Misty Gangar
- Tallahassee Memorial Healthcare, Tallahassee, FL, USA
| | | | - Shastri Motilal
- Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
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Xiong T, Yue Y, Li WX, Choonara I, Qazi S, Chen HJ, Tang J, Shi J, Wang H, Zeng LN, Xia B, Qiao LN, Qu Y, Mu DZ. Effectiveness of azithromycin mass drug administration on trachoma: a systematic review. Chin Med J (Engl) 2021; 134:2944-2953. [PMID: 34665571 PMCID: PMC8710348 DOI: 10.1097/cm9.0000000000001717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUNDS Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. RESULTS A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. CONCLUSIONS Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
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Affiliation(s)
- Tao Xiong
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Yue
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wen-Xing Li
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Hong-Ju Chen
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jun Tang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jing Shi
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hua Wang
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-Nan Zeng
- Department of Pharmacy, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, Sichuan 610041, China
| | - Bin Xia
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-Na Qiao
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Qu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - De-Zhi Mu
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, China
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Oldenburg CE, Pinsky BA, Brogdon J, Chen C, Ruder K, Zhong L, Nyatigo F, Cook CA, Hinterwirth A, Lebas E, Redd T, Porco TC, Lietman TM, Arnold BF, Doan T. Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection: A Randomized Clinical Trial. JAMA 2021; 326:490-498. [PMID: 34269813 PMCID: PMC8285753 DOI: 10.1001/jama.2021.11517] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Azithromycin has been hypothesized to have activity against SARS-CoV-2. OBJECTIVE To determine whether oral azithromycin in outpatients with SARS-CoV-2 infection leads to absence of self-reported COVID-19 symptoms at day 14. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of azithromycin vs matching placebo conducted from May 2020 through March 2021. Outpatients from the US were enrolled remotely via internet-based surveys and followed up for 21 days. Eligible participants had a positive SARS-CoV-2 diagnostic test result (nucleic acid amplification or antigen) within 7 days prior to enrollment, were aged 18 years or older, and were not hospitalized at the time of enrollment. Among 604 individuals screened, 297 were ineligible, 44 refused participation, and 263 were enrolled. Participants, investigators, and study staff were masked to treatment randomization. INTERVENTIONS Participants were randomized in a 2:1 fashion to a single oral 1.2-g dose of azithromycin (n = 171) or matching placebo (n = 92). MAIN OUTCOMES AND MEASURES The primary outcome was absence of self-reported COVID-19 symptoms at day 14. There were 23 secondary clinical end points, including all-cause hospitalization at day 21. RESULTS Among 263 participants who were randomized (median age, 43 years; 174 [66%] women; 57% non-Hispanic White and 29% Latinx/Hispanic), 76% completed the trial. The trial was terminated by the data and safety monitoring committee for futility after the interim analysis. At day 14, there was no significant difference in proportion of participants who were symptom free (azithromycin: 50%; placebo: 50%; prevalence difference, 0%; 95% CI, -14% to 15%; P > .99). Of 23 prespecified secondary clinical end points, 18 showed no significant difference. By day 21, 5 participants in the azithromycin group had been hospitalized compared with 0 in the placebo group (prevalence difference, 4%; 95% CI, -1% to 9%; P = .16). CONCLUSIONS AND RELEVANCE Among outpatients with SARS-CoV-2 infection, treatment with a single dose of azithromycin compared with placebo did not result in greater likelihood of being symptom free at day 14. These findings do not support the routine use of azithromycin for outpatient SARS-CoV-2 infection. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04332107.
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Affiliation(s)
- Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California
- Clinical Virology Laboratory, Stanford Health Care, Stanford, California
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Jessica Brogdon
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Cindi Chen
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Kevin Ruder
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Fanice Nyatigo
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Catherine A. Cook
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Travis Redd
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
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Oldenburg CE, Aragie S, Amza A, Solomon AW, Brogdon J, Arnold BF, Keenan JD, Lietman TM. Can we eradicate trachoma? A survey of stakeholders. Br J Ophthalmol 2021; 105:1059-1062. [PMID: 32855161 PMCID: PMC8311100 DOI: 10.1136/bjophthalmol-2020-315815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND/AIMS Although tremendous progress towards the 2020 goal of global elimination of trachoma as a public health problem has been made, it will not be achieved. Future targets are now being considered. One option is changing the goal to eradication. We surveyed trachoma experts to assess beliefs related to trachoma eradication and determine perceived obstacles to achieving it. METHODS We conducted a survey at the beginning of a trachoma eradication session at the 2019 Coalition for Operational Research on Neglected Tropical Diseases meeting in National Harbor, Maryland, USA. We asked respondents what the most important goal of azithromycin mass drug administration was for trachoma (control, elimination of infection or eradication) and if and when they believed trachoma eradication would occur. We then asked what the biggest obstacles were to global eradication. RESULTS Fifty-six surveys were returned (95%). Most (91%) participants reported that the most important goal of azithromycin mass drug administration was control or elimination of infection, and 24% of participants reported that global eradication was not possible. Of the 76% who reported a year by which they believed trachoma could be eradicated, most fell between 2040 and 2050. Commonly cited barriers to global eradication included lack of surveillance tools to confirm eradication or monitor for infection recrudescence (32%) and lack of resources (23%). CONCLUSIONS Development of alternative indicators for trachoma surveillance and continued investment in trachoma programmes, particularly focused support in the most heavily affected populations, might increase enthusiasm for the feasibility of eradication.
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Affiliation(s)
- Catherine E Oldenburg
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | | | - Abdou Amza
- Faculté Des Sciences De La Santé, Université Abdou Moumouni De Niamey, Niamey, Niger
- Programme National De Santé Oculaire, Niamey, Niger
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Jessica Brogdon
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Benjamin F Arnold
- Department of Ophthalmology, University of California, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Thomas M Lietman
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
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Mahmud H, Landskroner E, Amza A, Aragie S, Godwin WW, de Hostos Barth A, O’Brien KS, Lietman TM, Oldenburg CE. Stopping azithromycin mass drug administration for trachoma: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009491. [PMID: 34237074 PMCID: PMC8266061 DOI: 10.1371/journal.pntd.0009491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1–9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regions with low prevalence of active trachoma may have little if any ocular chlamydia, and, thus, may not benefit from azithromycin treatment. Understanding what happens to active trachoma and ocular chlamydia prevalence after stopping azithromycin MDA may improve future treatment decisions. We systematically reviewed published evidence for community prevalence of both active trachoma and ocular chlamydia after cessation of azithromycin distribution. We searched electronic databases for all peer-reviewed studies published before May 2020 that included at least 2 post-MDA surveillance surveys of ocular chlamydia and/or the active trachoma marker, trachomatous inflammation–follicular (TF) prevalence. We assessed trends in the prevalence of both indicators over time after stopping azithromycin MDA. Of 140 identified studies, 21 met inclusion criteria and were used for qualitative synthesis. Post-MDA, we found a gradual increase in ocular chlamydia infection prevalence over time, while TF prevalence generally gradually declined. Ocular chlamydia infection may be a better measurement tool compared to TF for detecting trachoma recrudescence in communities after stopping azithromycin MDA. These findings may guide future trachoma treatment and surveillance efforts. Trachoma, caused by repeated infections with ocular Chlamydia trachomatis, substantially contributes to the global burden of blindness. Community-wide distribution of the oral antibiotic azithromycin in trachoma endemic regions has contributed to significant decline in the prevalence of both ocular chlamydia infection and clinical findings of active trachoma. After azithromycin mass drug administration (MDA) stops, both ocular chlamydia and active trachoma can return. Our systematic review finds that ocular chlamydia infection may return to communities faster than signs of active trachoma, which may help better understand the utility of different trachoma indicators for post-MDA surveillance.
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Affiliation(s)
- Hamidah Mahmud
- University of California, San Francisco School of Medicine, San Francisco, California, United States of America
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Emma Landskroner
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
| | | | - William W. Godwin
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Anna de Hostos Barth
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
- * E-mail:
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38
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Cong W, Poudel AN, Alhusein N, Wang H, Yao G, Lambert H. Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review. Antibiotics (Basel) 2021; 10:antibiotics10060745. [PMID: 34205440 PMCID: PMC8235357 DOI: 10.3390/antibiotics10060745] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.
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Affiliation(s)
- Wenjuan Cong
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (N.A.); (H.L.)
- Correspondence: ; Tel.: +44-0117-3314528
| | - Ak Narayan Poudel
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.N.P.); (G.Y.)
| | - Nour Alhusein
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (N.A.); (H.L.)
| | - Hexing Wang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China;
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.N.P.); (G.Y.)
| | - Helen Lambert
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (N.A.); (H.L.)
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Oldenburg CE, Hinterwirth A, Worden L, Sié A, Dah C, Ouermi L, Coulibaly B, Zhong L, Chen C, Ruder K, Lietman TM, Keenan JD, Doan T. Indirect effect of oral azithromycin on the gut resistome of untreated children: a randomized controlled trial. Int Health 2021; 13:130-134. [PMID: 32556194 PMCID: PMC7902679 DOI: 10.1093/inthealth/ihaa029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 11/14/2022] Open
Abstract
Background Antibiotic use by one individual may affect selection for antimicrobial resistance in close contacts. Here we evaluated whether oral antibiotic treatment of one child within a household affected the gut resistome of an untreated cohabiting child. Methods Households with at least two children <5 y of age were randomized in a 1:1 fashion to a 5d course of azithromycin or placebo. To evaluate indirect effects of azithromycin treatment on the gut resistome, we randomly assigned one child in the house to azithromycin and one to placebo. In placebo households, each child received placebo. We performed DNA sequencing of rectal swabs collected 5 d after the last antibiotic dose. We estimated risk ratios for the presence of genetic resistance determinants at the class level using modified Poisson models for children in azithromycin households compared with placebo households and assessed the composition of the resistome using permutational analysis of variance (PERMANOVA). Results Of 58 children (n = 30 azithromycin households, n = 28 placebo households) with post-treatment rectal swabs, genetic resistance determinants were common but there was no significant difference at the class (p = 0.54 for macrolides) or gene (p = 0.94 for structure by PERMANOVA, p = 0.94 for diversity) level between untreated children in azithromycin households compared with placebo households. Conclusions The results are encouraging that one child's antibiotic use may not influence the resistome of another child. Trial registration:ClinicalTrials.gov NCT03187834.
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Affiliation(s)
- Catherine E Oldenburg
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Armin Hinterwirth
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Lee Worden
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Lucienne Ouermi
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Boubacar Coulibaly
- Centre de Recherche en Santé de Nouna, Rue Namory Keita, Nouna, Burkina Faso
| | - Lina Zhong
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Cindi Chen
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kevin Ruder
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Thuy Doan
- Francis I Proctor Foundation, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
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40
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Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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41
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Ramblière L, Guillemot D, Delarocque-Astagneau E, Huynh BT. Impact of mass and systematic antibiotic administration on antibiotic resistance in low- and middle-income countries? A systematic review. Int J Antimicrob Agents 2021; 58:106364. [PMID: 34044108 DOI: 10.1016/j.ijantimicag.2021.106364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/09/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
Antibiotic consumption is a key driver of antimicrobial resistance (AR), particularly in low- and middle-income countries (LMICs) where risk factors for AR emergence and spread are prevalent. However, the potential contribution of mass drug administration (MDA) and systematic drug administration (SDA) of antibiotics to AR spread is unknown. We conducted a systematic review to provide an overview of MDA/SDA in LMICs, including indications, antibiotics used and, if investigated, levels of AR over time. This systematic review is reported in accordance with the PRISMA statement. Of 2438 identified articles, 63 were reviewed: indications for MDA/SDA were various, and targeted populations were particularly vulnerable, including pregnant women, children, human immunodeficiency virus (HIV)-infected populations, and communities in outbreak settings. Available data suggest that MDA/SDA may lead to a significant increase in AR, especially following azithromycin administration. However, only 40% of studies evaluated AR. Integrative approaches that evaluate AR in addition to clinical outcomes are needed to understand the consequences of MDA/SDA implementation, combined with standardised AR surveillance for timely detection of AR emergence.
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Affiliation(s)
- Lison Ramblière
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015, Paris, France.
| | - Didier Guillemot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015, Paris, France; AP-HP Paris Saclay, Public Health, Medical Information, Clinical Research, F-94276, Le Kremlin-Bicêtre, France
| | - Elisabeth Delarocque-Astagneau
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; AP-HP Paris Saclay, Public Health, Medical Information, Clinical Research, F-94276, Le Kremlin-Bicêtre, France
| | - Bich-Tram Huynh
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015, Paris, France
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42
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Sié A, Ouattara M, Bountogo M, Dah C, Compaoré G, Boudo V, Lebas E, Brogdon J, Nyatigo F, Arnold BF, Lietman TM, Oldenburg CE. Indication for antibiotic prescription among children attending primary healthcare services in rural Burkina Faso. Clin Infect Dis 2021; 73:1288-1291. [PMID: 34018004 PMCID: PMC8492132 DOI: 10.1093/cid/ciab471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
We evaluated diagnoses leading to antibiotic use for children <5 years in 48 government-run primary health facilities in Nouna District, Burkina Faso. Among 61,355 visits, 30,975 received an antibiotic (58% pneumonia). Diagnoses not requiring an antibiotic, including malaria, non-bloody diarrhea, and cough without pneumonia, contributed a minority of antibiotic prescriptions.
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Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Valentin Boudo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA
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43
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O'Brien KS, Arzika AM, Amza A, Maliki R, Ousmane S, Kadri B, Nassirou B, Mankara AK, Harouna AN, Colby E, Lebas E, Liu Z, Le V, Nguyen W, Keenan JD, Oldenburg CE, Porco TC, Doan T, Arnold BF, Lietman TM. Age-based targeting of biannual azithromycin distribution for child survival in Niger: an adaptive cluster-randomized trial protocol (AVENIR). BMC Public Health 2021; 21:822. [PMID: 33926403 PMCID: PMC8082631 DOI: 10.1186/s12889-021-10824-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biannual distribution of azithromycin to children 1-59 months old reduced mortality by 14% in a cluster-randomized trial. The World Health Organization has proposed targeting this intervention to the subgroup of children 1-11 months old to reduce selection for antimicrobial resistance. Here, we describe a trial designed to determine the impact of age-based targeting of biannual azithromycin on mortality and antimicrobial resistance. METHODS AVENIR is a cluster-randomized, placebo-controlled, double-masked, response-adaptive large simple trial in Niger. During the 2.5-year study period, 3350 communities are targeted for enrollment. In the first year, communities in the Dosso region will be randomized 1:1:1 to 1) azithromycin 1-11: biannual azithromycin to children 1-11 months old with placebo to children 12-59 months old, 2) azithromycin 1-59: biannual azithromycin to children 1-59 months old, or 3) placebo: biannual placebo to children 1-59 months old. Regions enrolled after the first year will be randomized with an updated allocation based on the probability of mortality in children 1-59 months in each arm during the preceding study period. A biannual door-to-door census will be conducted to enumerate the population, distribute azithromycin and placebo, and monitor vital status. Primary mortality outcomes are defined as all-cause mortality rate (deaths per 1000 person-years) after 2.5 years from the first enrollment in 1) children 1-59 months old comparing the azithromycin 1-59 and placebo arms, 2) children 1-11 months old comparing the azithromycin 1-11 and placebo arm, and 3) children 12-59 months in the azithromycin 1-11 and azithromycin 1-59 arms. In the Dosso region, 50 communities from each arm will be followed to monitor antimicrobial resistance. Primary resistance outcomes will be assessed after 2 years of distributions and include 1) prevalence of genetic determinants of macrolide resistance in nasopharyngeal samples from children 1-59 months old, and 2) load of genetic determinants of macrolide resistance in rectal samples from children 1-59 months old. DISCUSSION As high-mortality settings consider this intervention, the results of this trial will provide evidence to support programmatic and policy decision-making on age-based strategies for azithromycin distribution to promote child survival. TRIAL REGISTRATION This trial was registered on January 13, 2020 (clinicaltrials.gov: NCT04224987 ).
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Affiliation(s)
- Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Ahmed M Arzika
- Centre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.,Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Abdou Amza
- Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Ramatou Maliki
- Centre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.,Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Sani Ousmane
- Centre de Recherche Médical et Sanitaire, Niamey, Niger
| | | | | | - Alio Karamba Mankara
- Centre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.,Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Abdoul Naser Harouna
- Centre de Recherche et Interventions en Santé Publique, Birni N'Gaoure, Niger.,Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Emily Colby
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Zijun Liu
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Victoria Le
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - William Nguyen
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois Street, San Francisco, CA, 94158, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.,Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, USA. .,Department of Ophthalmology, University of California, 490 Illinois Street, San Francisco, CA, 94158, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. .,Institute for Global Health Sciences, University of California, San Francisco, USA.
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A 2-pyridone amide inhibitor of transcriptional activity in Chlamydia trachomatis. Antimicrob Agents Chemother 2021; 95:AAC.01826-20. [PMID: 33593835 PMCID: PMC8092867 DOI: 10.1128/aac.01826-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chlamydia trachomatis is a strict intracellular bacterium that causes sexually transmitted infections and eye infections that can lead to life-long sequelae. Treatment options are limited to broad-spectrum antibiotics that disturb the commensal flora and contribute to selection of antibiotic-resistant bacteria. Hence, development of novel drugs that specifically target C. trachomatis would be beneficial. 2-pyridone amides are potent and specific inhibitors of Chlamydia infectivity. The first generation compound KSK120, inhibits the developmental cycle of Chlamydia resulting in reduced infectivity of progeny bacteria. Here, we show that the improved, highly potent second-generation 2-pyridone amide KSK213 allowed normal growth and development of C. trachomatis and the effect was only observable upon re-infection of new cells. Progeny elementary bodies (EBs) produced in the presence of KSK213 were unable to activate transcription of essential genes in early development and did not differentiate into the replicative form, the reticulate body (RB). The effect was specific to C. trachomatis since KSK213 was inactive in the closely related animal pathogen C. muridarum and in C. caviae The molecular target of KSK213 may thus be different in C. trachomatis or non-essential in C. muridarum and C. caviae Resistance to KSK213 was mediated by a combination of amino acid substitutions in both DEAD/DEAH RNA helicase and RNAse III, which may indicate inhibition of the transcriptional machinery as the mode of action. 2-pyridone amides provide a novel antibacterial strategy and starting points for development of highly specific drugs for C. trachomatis infections.
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Oldenburg CE, Sié A, Ouattara M, Bountogo M, Boudo V, Kouanda I, Lebas E, Brogdon JM, Lin Y, Nyatigo F, Arnold BF, Lietman TM. Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort. BMC Health Serv Res 2021; 21:212. [PMID: 33750364 PMCID: PMC7941928 DOI: 10.1186/s12913-021-06226-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Delays in care-seeking for childhood illness may lead to more severe outcomes. We evaluated whether community distance from a primary healthcare facility was associated with decreased healthcare utilization in a rural district of northwestern Burkina Faso. Methods We conducted passive surveillance of all government-run primary healthcare facilities in Nouna District, Burkina Faso from March 1 through May 31, 2020. All healthcare visits for children under 5 years of age were recorded on a standardized form for sick children. We recorded the age, sex, and community of residence of the child as well as any diagnoses and treatments administered. We calculated healthcare utilization per 100 child-months by linking the aggregate number of visits at the community level to the community’s population of children under 5 months per a census that was conducted from August 2019 through February 2020. We calculated the distance between each community and its corresponding healthcare facility and assessed the relationship between distance and the rate of healthcare utilization. Results In 226 study communities, 12,676 primary healthcare visits were recorded over the three-month period. The median distance between the community and primary healthcare facility was 5.0 km (IQR 2.6 to 6.9 km), and median number of healthcare visits per 100 child-months at the community level was 6.7 (IQR 3.7 to 12.3). The rate of primary healthcare visits declined with increasing distance from clinic (Spearman’s rho − 0.42, 95% CI − 0.54 to − 0.31, P < 0.0001). This relationship was similar for cause-specific clinic visits (including pneumonia, malaria, and diarrhea) and for antibiotic prescriptions. Conclusions We documented a distance decay effect between community distance from a primary healthcare facility and the rate of healthcare visits for children under 5. Decreasing distance-related barriers, for example by increasing the number of facilities or targeting outreach to more distant communities, may improve healthcare utilization for young children in similar settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06226-5.
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Affiliation(s)
- Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA. .,Department of Ophthalmology, University of California, San Francisco, USA. .,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Valentin Boudo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Elodie Lebas
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Jessica M Brogdon
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Ying Lin
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, Fuller NM, Willcocks SJ, Hasan R, van Kleef E, Chandler CIR. Antimicrobial resistance and COVID-19: Intersections and implications. eLife 2021; 10:e64139. [PMID: 33588991 PMCID: PMC7886324 DOI: 10.7554/elife.64139] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.
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Affiliation(s)
- Gwenan M Knight
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
- TB Centre, LSHTMLondonUnited Kingdom
| | - Rebecca E Glover
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTMLondonUnited Kingdom
| | - C Finn McQuaid
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
- TB Centre, LSHTMLondonUnited Kingdom
| | - Ioana D Olaru
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
- Biomedical Research and Training InstituteZambezi RiverZimbabwe
| | - Karin Gallandat
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Quentin J Leclerc
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
| | - Naomi M Fuller
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
| | - Sam J Willcocks
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Rumina Hasan
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Pathology and Laboratory Medicine, Aga Khan UniversityKarachiPakistan
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Esther van Kleef
- Department of Public Heath, Institute of Tropical MedicineAntwerpBelgium
| | - Clare IR Chandler
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Global Health and Development, Faculty of Public Health and Policy, LSHTMLondonUnited Kingdom
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47
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Guglielmino CJD, Kakkanat A, Forde BM, Rubenach S, Merone L, Stafford R, Graham RMA, Beatson SA, Jennison AV. Outbreak of multi-drug-resistant (MDR) Shigella flexneri in northern Australia due to an endemic regional clone acquiring an IncFII plasmid. Eur J Clin Microbiol Infect Dis 2021; 40:279-286. [PMID: 32888117 PMCID: PMC7473701 DOI: 10.1007/s10096-020-04029-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022]
Abstract
Epidemiological surveillance of Shigella spp. in Australia is conducted to inform public health response. Multi-drug resistance has recently emerged as a contributing factor to sustained local transmission of Shigella spp. All data were collected as part of routine public health surveillance, and strains were whole-genome sequenced for further molecular characterisation. 108 patients with an endemic regional Shigella flexneri strain were identified between 2016 and 2019. The S. flexneri phylogroup 3 strain endemic to northern Australia acquired a multi-drug resistance conferring blaDHA plasmid, which has an IncFII plasmid backbone with virulence and resistance elements typically found in IncR plasmids. This is the first report of multi-drug resistance in Shigella sp. in Australia that is not associated with men who have sex with men. This strain caused an outbreak of multi-drug-resistant S. flexneri in northern Australia that disproportionality affects Aboriginal and Torres Strait Islander children. Community controlled public health action is recommended.
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Affiliation(s)
- Christine J D Guglielmino
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Australia.
| | - Asha Kakkanat
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Australia
| | - Brian M Forde
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia
| | - Sally Rubenach
- Tropical Public Health Services, Queensland Health, Cairns, Australia
| | - Lea Merone
- Rural and Remote Clinical Support Unit, Apunipima Cape York Health Council, Cairns, Australia
| | - Russell Stafford
- Communicable Diseases Unit, Queensland Health, Brisbane, Australia
| | - Rikki M A Graham
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia
| | - Amy V Jennison
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Australia
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Mack I, Sharland M, Berkley JA, Klein N, Malhotra-Kumar S, Bielicki J. Antimicrobial Resistance Following Azithromycin Mass Drug Administration: Potential Surveillance Strategies to Assess Public Health Impact. Clin Infect Dis 2021; 70:1501-1508. [PMID: 31633161 DOI: 10.1093/cid/ciz893] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022] Open
Abstract
The reduction in childhood mortality noted in trials investigating azithromycin mass drug administration (MDA) for trachoma control has been confirmed by a recent large randomized controlled trial. Population-level implementation of azithromycin MDA may lead to selection of multiresistant pathogens. Evidence suggests that repeated azithromycin MDA may result in a sustained increase in macrolide and other antibiotic resistance in gut and respiratory bacteria. Current evidence comes from standard microbiological techniques in studies focused on a time-limited intervention, while MDA implemented for mortality benefits would likely repeatedly expose the population over a prolonged period and may require a different surveillance approach. Targeted short-term and long-term surveillance of resistance emergence to key antibiotics, especially those from the World Health Organization Access group, is needed throughout any implementation of azithromycin MDA, focusing on a genotypic approach to overcome the limitations of resistance surveillance in indicator bacteria.
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Affiliation(s)
- Ines Mack
- Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland
| | - Mike Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - James A Berkley
- Center for Tropical Medicine and Global Health, University of Oxford, United Kingdom.,KEMRI/Wellcome Trust Research Program, Kilifi, Kenya
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Universiteit Antwerpen, Antwerp, Belgium
| | - Julia Bielicki
- Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland.,Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
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49
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Amza A, Kadri B, Nassirou B, Arzika AM, Austin A, Nyatigo F, Lebas E, Arnold BF, Lietman TM, Oldenburg CE. Azithromycin Reduction to Reach Elimination of Trachoma (ARRET): study protocol for a cluster randomized trial of stopping mass azithromycin distribution for trachoma. BMC Ophthalmol 2021; 21:15. [PMID: 33407263 PMCID: PMC7789605 DOI: 10.1186/s12886-020-01776-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022] Open
Abstract
Background The World Health Organization (WHO) recommends annual mass azithromycin distribution until districts drop below 5% prevalence of trachomatous inflammation—follicular (TF). Districts with very low TF prevalence may have little or no transmission of the ocular strains of Chlamydia trachomatis that cause trachoma, and additional rounds of mass azithromycin distribution may not be useful. Here, we describe the protocol for a randomized controlled trial designed to evaluate whether mass azithromycin distribution can be stopped prior to the current WHO guidelines. Methods The Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) study is a 1:1 community randomized non-inferiority trial designed to evaluate whether mass azithromycin distribution can be stopped in districts with baseline prevalence of TF under 20%. Communities in Maradi, Niger are randomized after baseline assessment either to continued annual mass azithromycin distribution or stopping annual azithromycin distribution over a 3-year period. We will compare the prevalence of ocular C. trachomatis (primary outcome), TF and other clinical signs of trachoma, and serologic markers of trachoma after 3 years. We hypothesize that stopping annual azithromycin distribution will be non-inferior to continued annual azithromycin distributions for all markers of trachoma prevalence and transmission. Discussion The results of this trial are anticipated to provide potentially guideline-changing evidence for when mass azithromycin distributions can be stopped in low TF prevalence areas. Trial registration number This study is registered at clinicaltrials.gov (NCT04185402). Registered December 4, 2019; prospectively registered pre-results.
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Affiliation(s)
- Abdou Amza
- Programme National de Santé Oculaire, Ministere de la Santé Publique, Niamey, Niger
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Ministere de la Santé Publique, Niamey, Niger
| | - Beido Nassirou
- Programme National de Santé Oculaire, Ministere de la Santé Publique, Niamey, Niger
| | - Ahmed M Arzika
- Centre de Recherche et d'Intervention en Santé Publique, Niamey, Niger
| | - Ariana Austin
- Francis I Proctor Foundation, University of California, San Francisco, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, San Francisco, USA
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94158, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, USA.,Department of Ophthalmology, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94158, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, USA. .,Department of Ophthalmology, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94158, USA. .,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
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50
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Rodríguez-Álvarez M, López-Vidal Y, Soto-Hernández JL, Miranda-Novales MG, Flores-Moreno K, Ponce de León-Rosales S. COVID-19: Clouds Over the Antimicrobial Resistance Landscape. Arch Med Res 2021; 52:123-126. [PMID: 33070986 PMCID: PMC7547601 DOI: 10.1016/j.arcmed.2020.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022]
Abstract
In recent years, the increase in antimicrobial resistance (AMR) has been recognized as a real threat to human and animal health. It is a problem that has been given the highest priority, uniting nations in the fight against its causes and effects. Among the actions that have been implemented are: clinical and microbiological surveillance, promotion of rational and controlled use of antibiotics, AMR stewardship programs in hospitals, development of tools for rapid diagnosis of infectious diseases to establish prompt and adequate treatment, and radically improving vaccination strategies. The current COVID-19 pandemic has placed disproportionate demands on the healthcare infrastructure and economy worldwide, which will negatively impact on the availability of materials as well as the technical capacity for diagnosis, patient care, and treatment of both COVID-19 and non-COVID-19 patients. Disruptions to production and distribution chains will hamper the availability and usage of antibiotics, also interrupting several of the activities that have been implemented thus far to combat AMR, including detailed laboratory monitoring and reinforced vaccination programs. Here, we discuss the main aspects that should be considered with regard to AMR, that may be affected by the pandemic and propose some actions to counter them.
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Affiliation(s)
- Mauricio Rodríguez-Álvarez
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México.
| | - Yolanda López-Vidal
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - José Luis Soto-Hernández
- Departamento de Infectología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - María Guadalupe Miranda-Novales
- Unidad de Investigación en Análisis y Síntesis de la Evidencia, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Karen Flores-Moreno
- Laboratorio de Microbioma, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Samuel Ponce de León-Rosales
- Programa Universitario de Investigación en Salud, Universidad Nacional Autónoma de México, Ciudad de México, México
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