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Randomized trial of community treatment with azithromycin and ivermectin mass drug administration for control of scabies and impetigo

journal contribution
posted on 05.06.2019, 00:00 authored by M Marks, H Toloka, C Baker, C Kositz, J Asugeni, E Puiahi, R Asugeni, K Azzopardi, J Diau, JM Kaldor, Michelle Redman-MaclarenMichelle Redman-Maclaren, David MacLaren
Background Scabies is a public health problem in many countries, with impetigo and its complications important consequences. Ivermectin based mass drug administration (MDA) reduces the prevalence of scabies and, to a lesser extent, impetigo. We studied the impact of co-administering azithromycin on the prevalence of impetigo and antimicrobial resistance. Methods Six communities were randomized to receive either ivermectin-based MDA or ivermectin-based MDA co-administered with azithromycin. We measured scabies and impetigo prevalence at baseline and 12 months. We collected impetigo lesions swabs at baseline, 3 and 12 months to detect antimicrobial resistance. Results At baseline, scabies and impetigo prevalences were 11.8% and 10.1% in the ivermectin-only arm and 9.2% and 12.1% in the combined treatment arm. At 12 months, the prevalences had fallen to 1.0% and 2.5% in the ivermectin-only arm and 0.7% and 3.3% in the combined treatment arm. The proportion of impetigo lesions containing Staphylococcus aureus detected did not change (80% at baseline vs 86% at 12 months; no significant difference between arms) but the proportion containing pyogenic streptococci fell significantly (63% vs 23%, P <.01). At 3 months, 53% (8/15) of S. aureus isolates were macrolide-resistant in the combined treatment arm, but no resistant strains (0/13) were detected at 12 months. Conclusions Co-administration of azithromycin with ivermectin led to similar decreases in scabies and impetigo prevalence compared to ivermectin alone. The proportion of impetigo lesions containing pyogenic streptococci declined following MDA. There was a transient increase in the proportion of macrolide-resistant S. aureus strains following azithromycin MDA. Clinical Trials Registration clinicaltrials.gov (NCT02775617). © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.

History

Volume

68

Issue

6

Start Page

927

End Page

933

Number of Pages

7

eISSN

1537-6591

ISSN

1058-4838

Publisher

Oxford University Press, UK

Additional Rights

CC BY 4.0

Peer Reviewed

Yes

Open Access

Yes

Acceptance Date

06/07/2018

External Author Affiliations

James Cook University; University of New South Wales; University of Melbourne; Royal Children’s Hospital, Melbourne; Murdoch Children’s Research Institute, Melbourne; University College London Hospitals NHS Trust, UK; National Referral Hospital, Atoifi Adventist Hospital, Soloman Islands

Era Eligible

Yes

Journal

Clinical Infectious Diseases