Simplification and improvement of height-based azithromycin treatment for paediatric trachoma

Recent data showing that azithromycin is safe at higher dosages than previously documented provide an opportunity to explore several important improvements in the efficiency and effectiveness of height-based treatment of paediatric trachoma. The purpose of this study is to examine the feasibility of a single standardised schedule for application in any trachoma-endemic region. Data for 60 813 children from Asia, North and sub-Saharan Africa were analysed. A height schedule maximizing the number of children receiving treatment of 20-40 mg/kg, a conservative estimate of the safe and effective treatment range for paediatric trachoma, was developed. Using the standardised schedule, 97.7% of children aged 6 to 59 months receiving oral suspension and 96.7% of children aged 60 months to 15 years receiving tablets would have received treatment within a dosage range of 20-40 mg/kg. Less than 1% of all children would have received treatment less than 20 mg/kg. These findings suggest that the schedule presented in this paper is likely to yield safe and effective treatment for a broad range of populations vulnerable to trachoma while substantially improving the efficiency of height-based treatment.