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Randomized trial of community treatment with azithromycin and ivermectin mass drug administration for control of scabies and impetigo
Version 2 2022-10-14, 02:28Version 2 2022-10-14, 02:28
Version 1 2021-01-18, 19:51Version 1 2021-01-18, 19:51
journal contribution
posted on 2019-06-05, 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-Maclaren, David MacLarenBackground 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
68Issue
6Start Page
927End Page
933Number of Pages
7eISSN
1537-6591ISSN
1058-4838Publisher
Oxford University Press, UKPublisher DOI
Additional Rights
CC BY 4.0Peer Reviewed
- Yes
Open Access
- Yes
Acceptance Date
2018-07-06External 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 IslandsEra Eligible
- Yes
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Clinical Infectious DiseasesUsage metrics
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