Medication Summary
The aim in treatment is to reduce the amount C trachomatis in the infection reservoir in the family. Treating an individual and not treating infected family members leaves the individual at risk for repeat infection. All family members, including infants, should be treated.
The antibiotic of choice for treating active trachoma is azithromycin. The dose for children is 20 mg/kg in a single dose; adults receive a single dose of 1 g. The second-line treatment is topical tetracycline eye ointment 1%. Topical tetracycline is applied to both eyes twice a day for 6 weeks.
If the patient lives in a hyperendemic area, the whole district (or whole community) is eligible for antibiotic treatment.
Antibiotics
Class Summary
Antibiotic therapy is part of the WHO SAFE strategy for trachoma.
Azithromycin (Zithromax)
Azithromycin is a macrolide antibiotic and is the drug of choice for trachoma. Plasma concentrations are low, but tissue concentrations are higher, giving it value in treating intracellular organisms. It has a long tissue half-life. A single dose is recommended.
1% Tetracycline ointment (Achromycin)
Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit. Use if azithromycin is unavailable. Minimal systemic adverse effects.
Azithromycin ophthalmic (AzaSite)
Azithromycin ophthalmic is an ophthalmic macrolide antibiotic indicated for bacterial conjunctivitis caused by CDC coryneform group G bacteria, Haemophilus influenzae, Staphylococcus aureus, Streptococcus mitis group, and Streptococcus pneumoniae.
-
Trachomatous inflammation, follicular (TF), is the presence of 5 or more follicles (each at least 0.5 mm in diameter) on the central part of the upper tarsal conjunctiva. Images from the Slides/Text Teaching Series, No. 7, Trachoma, published by The International Centre for Eye Health, Institute of Ophthalmology, 11-43 Bath St, London EC1V 9EL, United Kingdom. Photograph courtesy of John D. C. Anderson, MD.
-
Trachomatous inflammation, intense (TI) is pronounced inflammatory thickening of the upper tarsal conjunctiva that obscures more than one half the normal deep tarsal vessels. Photograph courtesy of Allen Foster, MD.
-
Trachomatous conjunctival scarring (TS) is the presence of easily visible scars in the tarsal conjunctiva.
-
Trachomatous trichiasis (TT) is defined as the presence of at least 1 eyelash rubbing on the eyeball or evidence of recent removal of in-turned lashes. Photograph courtesy of John D. C. Anderson, MD.
-
Easily visible corneal opacity over the pupil; it is so dense that at least part of the pupil margin is blurred when viewed through the opacity. Photograph courtesy of John D. C. Anderson, MD.
-
The image on the left shows intense inflammatory trachoma, and the image on the right shows allergic conjunctivitis with the typical cobblestone papillae. Courtesy of John D. C. Anderson, MD, and Murray McGavin, MD.
