Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
public health measures
Treatment recommended for ALL patients in selected patient group
Evidence to support the efficacy of interventions targeting facial cleanliness and environmental improvements is limited.[55] Facial cleanliness, in conjunction with mass antibiotic treatment, may be effective in reducing severe active trachoma.[55]
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Washing with soap may remove ocular discharge more effectively than washing with water alone.[56] There is no conclusive evidence to support face washing in isolation.[55] One cluster-randomised trial reported no reduction in ocular chlamydia prevalence among both intervention and control groups 36 months after the implementation of a facial cleanliness plus environmental improvement programme.[29] The trial is ongoing.
Access to a clean water supply, adequate latrines and refuse disposal, and attempts to minimise fly density are all potentially important factors for trachoma control.[9][18][19] However, delivered in isolation (e.g., in the absence of an educational campaign, or concurrent antibiotic therapy) these measures are unlikely to be effective.[29][57][58]
alternative antibiotic therapy for patient and community (or family)
Patients without access to azithromycin (e.g., due to cost) should be treated with topical tetracycline ointment. If this is unavailable, oral erythromycin can be used. There is no proven difference in benefit between the various antibiotic regimens.[48]
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If the prevalence of active trachoma is greater than 10% in children aged 1 to 9 years, the World Health Organization (WHO) recommends treatment of all members of a community older than aged 6 months with mass antibiotic distribution on an annual basis for a total of 3 years.[36] This approach is supported by randomised controlled trials.[41][42] Infants aged 1 to 6 months are an important reservoir of infection and there is growing opinion that they should be included within any mass treatment programme.[43][44] Antibiotic distribution should be undertaken in conjunction with a range of public health measures.[45]
If those affected are confined to several large families within a small community, it may be possible to target those large families.
Primary options
tetracycline topical: (1% ophthalmic ointment) apply to the affected eye(s) twice daily for 6 weeks with course repeated on an annual basis for a total of 3 years
Secondary options
erythromycin base: children: 30-50 mg/kg/day orally given in divided doses every 6 hours for 7 days, with course repeated on an annual basis for a total of 3 years; adults: 250 mg orally every 6 hours for 2 weeks, with course repeated on an annual basis for a total of 3 years
public health measures
Treatment recommended for ALL patients in selected patient group
Evidence to support the efficacy of interventions targeting facial cleanliness and environmental improvements is limited.[55] Facial cleanliness, in conjunction with mass antibiotic treatment, may be effective in reducing severe active trachoma.[55]
[ ]
Washing with soap may remove ocular discharge more effectively than washing with water alone.[56] There is no conclusive evidence to support face washing in isolation.[55] One cluster-randomised trial reported no reduction in ocular chlamydia prevalence among both intervention and control groups 36 months after the implementation of a facial cleanliness plus environmental improvement programme.[29] The trial is ongoing.
Access to a clean water supply, adequate latrines and refuse disposal, and attempts to minimise fly density are all potentially important factors for trachoma control.[9][18][19] However, delivered in isolation (e.g., in the absence of an educational campaign, or concurrent antibiotic therapy) these measures are unlikely to be effective.[29][57][58]
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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