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Effect of oral azithromycin in the treatment of chlamydial conjunctivitis
Eye, 11/09/09
Chen YM et al. – Two weekly doses of oral azithromycin were effective and well tolerated in the treatment of chlamydial conjunctivitis. However, more than one course of treatment was necessary in some patients.
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Y-C Hou, 11/22/09
Y-C Hou, 11/22/09
| Chlamydia trachomatis is an obligate intracellular gram-negative eubacterium that can cause a wide variety of diseases and constitutes a considerable public health problem. C. trachomatis serotypes A, B, Ba, and C cause trachoma, which is endemic in many countries and also the leading infectious cause of blindness in the developing world. C. trachomatis serotypes D-K cause adult or neonatal inclusion conjunctivitis, and are among of the major causes of sexually transmitted disease in the industrialized countries. Chlamydia conjunctivitis can present as eye redness with mucopurulent discharge, marked hyperemia, papillary hypertrophy, and a predominant follicular conjunctivitis. In non-endemic areas, many patients with chlamydia conjunctivitis may just present pinkish, turbid follicles with vascularization but do not have other symptoms or signs. Ophthalmologist practitioners may ignore its presentation and misdiagnosed as a commonly chronic conjunctivitis. Clinically, it is not easy to diagnose the beginning of chlamydia conjunctivitis by its presentation only. The diagnosis can be confirmed by laboratory testing such as direct fluorescent antibody (DFA) test, polymerase chain reaction, and ligase chain reaction. Traditionally, the follicles were predominant at superior conjunctiva in trachoma and at inferior conjunctiva in adult inclusion conjunctivitis. Actually, it is unreliable to differentiate trachoma from adult inclusion conjunctivitis by the location of follicular conjunctivitis. Also C. trachomatis is not tissue selective. The serovars D-F, J and K have all been isolated from active trachoma. Oral single-dose of azithromycin (1000mg, or 20mg/kg in children) has been advocated to treat trachoma and shown a marked decrease of C. trachomatis infection and clinical trachoma after community-wide treatment in endemic areas. However, its efficacy was rare reported without mass treatment in non-endemic areas. According to my personal experience and the results of our study, the efficacy was about 70% after two weekly dose of oral azithromycin (1000 mg, or 20 mg/kg in children) and other 30% of patients needed one or two additional doses. The relatively low efficacy in our study compared with mass treatment in Africa may be due to reinfection or high loads of C. trachomatis in some patients. I have seen 2 cases who were resistant to our treatment or recurred again in a short period of time. Then I did DFA test in all members of these two families who had not symptoms of conjunctivitis and found more than two family members had positive results of testing. Conclusively, Ophthalmologist practitioners need to know the initial presentation of chlamydia conjunctivitis, which is not so rare as we expect in non-endemic areas. Most of patients with chlamydia conjunctivitis in non-endemic areas do not have severe symptoms, scarring or pannus formation. In our study, the accuracy of clinical diagnosis in chlamydia conjunctivitis was 67%. We should take chlamydia conjunctivitis into consideration if patients have a prolonged course of follicular conjunctivitis. We also suggest that oral single-dose of azithromycin may be not enough to eradicate Chlamydia infection in all cases and some of them need more additional doses. The family members of the affected subjects had better receive laboratory testing no matter whether they have symptoms or not. |
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