Randomised trial of community treatment with azithromycin and ivermectin mass drug administration for control of scabies and impetigo
Journal Publication ResearchOnline@JCUAbstract
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 randomised to receive either ivermectin-based MDA or ivermectin-based MDA co-administered with azithromycin. We measured scabies and impetigo prevalence at baseline and twelve months. We collected impetigo lesions swabs at baseline, three and twelve 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 twelve 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 twelve months; no significant difference between arms) but the proportion containing pyogenic streptococci fell significantly (63% vs 23%, p < 0.01). At three 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 twelve 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.
Journal
Clinical Infectious Diseases
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Volume
68
ISBN/ISSN
1537-6591
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Issue
6
Pages Count
7
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Publisher
University of Chicago Press
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DOI
10.1093/cid/ciy574