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Volume 10, Number 11—November 2004

Perspective

Trachoma Decline and Widespread Use of Antimicrobial Drugs

Jaya D. Chidambaram*, Mariko Bird*, Vivian Schiedler*, Alicia M. Fry†, Travis Porco‡, Ramesh C. Bhatta§, Hem Jha§, J.S.P. Chaudary§, Bruce Gaynor*, Elizabeth Yi*, John P. Whitcher*, Susie Osaki-Holm*, and Thomas M. Lietman*Comments to Author 
Author affiliations: *University of California, San Francisco, California, USA; †Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ‡California Department of Health Services, Berkeley, California, USA; §Geta Eye Hospital, Geta, Nepal

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Table

Comparison of antimicrobial drug use within and outside a trachoma programa

DDD/person/year to all ages Prescriptions/person/
year to preschool children
Antimicrobial pressure from pharmacies
   All antimicrobial drug prescriptions (from survey) 3.0 1.8
   Antichlamydial prescriptions (from survey) 2.0 1.2
Antimicrobial pressure from trachoma program
   Annual azithromycin treatment with 100% coverage (theoretical) 2.3 1
   Annual azithromycin treatment with 80% coverage (theoretical) 1.9 0.8

aPharmacy survey data showing the total quantity of antimicrobial drugs used in Geta subdistrict and the proportion of antimicrobial drug with antichlamydial activity. An annual trachoma program theoretically gives 1 g of azithromycin to every adult (3.3 DDDs) and a lower dosage to children, averaging approximately 2.3 DDDs per person for all ages. We estimate from a mathematical model that mass antimicrobial treatment every 1.7 years would be sufficient to eventually eliminate ocular chlamydial infection from this region (13). DDD, defined daily dose, the average adult daily dosage for a drug’s primary indication.

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