zithromax and Conjunctivitis--Inclusion

In this short review, new data on the taxonomy of Chlamydia and the association of these pathogens with various ocular diseases are presented. Clinical diagnosis and laboratory tests for ocular C. trachomatis infection are discussed. The actual therapy consists in oral azithromycin.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Conjunctivitis, Inclusion; Doxycycline; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Trachoma

Single-dose azithromycin (AZT) has been proved efficient in treating various human Chlamydia infections. However, it has not been thoroughly tested in patients with adult inclusion conjunctivitis (AIC). It is the aim of this study to perform a comparative evaluation of efficacy and safety of one-day AZT with long-term AZT and doxycycline (DOX) regimens in AIC and to present a clinical profile of regression course of the disease.. Eighty-three consecutive adults, with symptoms and signs of chronic conjunctivitis and positive Polymerase Chain Reaction (PCR) for chlamydia, were randomly assigned in four treatment groups; AZT 1-day 1000 mg orally, AZT 500 mg daily 9 and 14 days and DOX 200 mg 21 days orally. Follow-up visits were scheduled 1 and 2 weeks, 1, 3 and 6 months after treatment completion. PCR was repeated at the 2nd post-treatment week to confirm elimination of infectious agent. Detailed record of subjective symptoms and objective signs was performed at all visits. Retreatment rate among groups was evaluated as primary outcome. Regression rate of symptoms/signs among groups was recorded as secondary outcomes.. All treatment groups provided statistically equivalent results of retreatment rate. Statistically significant regression of symptoms/signs was documented, initially from the 1st post-treatment week in general, but 1 month was required for complete patients' relief. Follicles were the most common clinical sign with the earliest regression after successful treatment.. Single-dose azithromycin should be considered as equally reliable treatment option, comparing to long-term alternative regimens for AIC. Patients should wait for one week, until first signs of significant regression become obvious and should consider approximately one month to total relief. Follicles could be reasonably used as a key sign for clinical assessment of treatment success.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Chronic Disease; Conjunctivitis, Inclusion; Dose-Response Relationship, Drug; Doxycycline; Drug Therapy, Combination; Humans; Prospective Studies; Retreatment; Treatment Outcome

The aim of the study was to compare the efficacy and safety of azithromycin and doxycycline in the treatment of chlamydial conjunctivitis in adults.. An open, randomized clinical trial.. Seventy-eight adult patients with incluson conjunctivitis were enrolled in this multicenter clinical study. Patients with chlamydial conjunctivitis as indicated by a positive direct fluorescent antibody (DFA) test or cell culture were randomized to receive a single 1-g dose of azithromycin or doxycycline, 100 mg twice daily for 10 days. A conjuctival swab for cell culture was obtained from all patients immediately before the treatment for subsequent confirmation of the presence of chlamydial infection in the central laboratory. Control examinations were performed 10 to 12 days and 4 to 6 weeks after the treatment initiation. Clinical and bacteriological responses to the treatment were evaluated at the last visit. The occurrence and frequency of adverse events were analyzed as well.. Of 78 patients enrolled, 51 completed the study and were evaluated for efficacy. The main reasons for withdrawal were lack of confirmation of the presence of chlamydial infection by the central laboratory and failure to attend the follow-up visit. Eradication of C. trachomatis was achieved in 23 of 25 (92%) patients treated with azithromycin and in 25 of 26 (96%) patients treated with doxycycline. Clinical cure was observed in 15 (60%) and 18 (69%) patients treated with azithromycin and doxycycline, respectively. Both drugs were equally well tolerated.. A single 1-g azithromycin therapy was as effective as standard 10-day treatment with doxycycline (100 mg twice daily) in the treatment of adult inclusion conjunctivitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Conjunctiva; Conjunctivitis, Inclusion; Doxycycline; Female; Humans; Male; Middle Aged; Prospective Studies; Safety; Treatment Outcome

Topics: Anti-Bacterial Agents; Azithromycin; Conjunctivitis, Inclusion; Fluorescent Antibody Technique, Direct; Humans; Infant, Newborn

Topics: Azithromycin; Chlamydia trachomatis; Conjunctivitis, Inclusion; Conjunctivitis, Viral; Diagnosis, Differential; Humans; Male; Young Adult

Conjunctivitis is a frequently diagnosed disease, usually caused by a virus. A less well-known cause is a chlamydia infection. This may result in missed diagnoses, delay of treatment and several complications. We present two cases of a persistent, therapy-resistant conjunctivitis in patients who were over 70 years of age. One patient had conjunctival follicles, characteristic of chlamydia conjunctivitis. The polymerase chain reaction tests of conjunctival samples from both patients were positive for chlamydia. Both patients and their sexual partners were treated with oral azithromycin. There was a treatment delay in both cases due to late recognition which was partially due to the older age of the patients. These cases illustrate that when a patient presents with persistent, therapy-resistant conjunctivitis, particularly if conjunctival follicles are present, chlamydial conjunctivitis should be considered and conjunctival swabs should be taken, no matter what the age of the patient.

Topics: Aged; Azithromycin; Chlamydia trachomatis; Conjunctivitis, Inclusion; Diagnosis, Differential; Female; Humans; Male

Gonococcal conjunctivitis is a rare infection induced by Neisseria gonorrhoeae and it usually manifests as a hyperacute purulent conjunctivitis. Ocular access of the infectious secretion during sexual intercourse is the way of transmission among adults. Inclusion conjunctivitis caused by the serovars D-K of Chlamydia trachomatis also affects the sexually active population. Authors present a case of a 33-year-old homosexual man who was treated for late latent syphilis formerly. Clinical symptoms were yellow purulent discharge for 3 weeks without any urological or upper respiratory tract symptoms. Conjunctival Neisseria gonorrhoeae and Chlamydia trachomatis infection was identified using cultures and polymerase chain reaction; pharyngeal swab culture and polymerase chain reaction showed positive results for both pathogens. The patient was probably under influence of party drugs at the time of sexual abuse when he became infected. After parenteral and oral cephalosporin and azithromycin therapy the patient had complete recovery within three weeks.. A keratoconjunctivitis gonorrhoica ritka, a Neisseria gonorrhoeae által okozott gennyes váladékozással kísért kötőhártya-gyulladás, amelyet felnőtteknél a szembe kerülő fertőző váladék okozhat. A Chlamydia trachomatis D-K szerotípusa által okozott conjunctivitis felnőttkori formáját nemi váladékok szembe kerülésével létrejött, kétoldali mucopurulens váladékozással kísért gyulladás jellemzi. A szerzők egy 33 éves, syphilis latens tarda miatt gondozott férfi beteg esetét ismertetik, akinek a hetek óta fennálló purulens conjunctivitise hátterében a mikrobiológiai vizsgálatok során Chlamydia trachomatis-fertőzéssel kombinált Neisseria gonorrhoeae-infekció igazolódott. A tenyésztéses és PCR-vizsgálatok során a pharynxból is kimutatható volt mindkét kórokozó. A betegnek sem urológiai, sem felső légúti tünetei nem voltak. A fertőződés kábítószer hatása alatt történt szexuális abúzust követően alakult ki. A parenteralis, majd per os cephalosporin- és azithromycinterápia hatására három hét alatt teljes remisszió következett be. Orv. Hetil., 2013, 154, 834–837.

Topics: Acute Disease; Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; Cephalosporins; Chlamydia trachomatis; Coinfection; Conjunctivitis, Bacterial; Conjunctivitis, Inclusion; Homosexuality, Male; Humans; Injections, Intravenous; Male; Neisseria gonorrhoeae; Polymerase Chain Reaction; Sex Offenses; Sexual Behavior; Staphylococcus aureus

To assess the efficacy of oral azithromycin in the treatment of chlamydial conjunctivitis.. We performed a retrospective study in patients with clinically suspected chlamydial conjunctivitis who underwent conjunctival swab sampling for Chlamydia direct fluorescent antibody (DFA) tests between 1 January 2006 and 31 December 2006. Patients with positive DFA results were orally administered azithromycin once a week for 2 consecutive weeks. If DFA examinations still showed positive results after 4 weeks, additional azithromycin was orally administered once. The DFA tests were repeated 4 weeks later, and this was continued until the DFA tests showed negative results.. Among the 67 suspected patients, 45 (67.2%) showed positive results from the DFA tests, of whom 42 received treatment. After the first 2 weeks, only 27 patients returned to the clinic and completed the treatment. The test results of 19 (70.4%) patients became negative after the treatment with two weekly doses of oral azithromycin. Among the remaining eight patients, four (14.8%) needed an additional dose of oral azithromycin, and the other four (14.8%) required two additional doses. All 27 patients tolerated the treatment well, with an adverse event of mild gastritis in only one patient.. 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.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Chlamydia trachomatis; Conjunctiva; Conjunctivitis, Inclusion; Female; Humans; Male; Middle Aged; Retrospective Studies; Young Adult

Azithromycin (AZM) is a major drug used in the treatment and prophylaxis of infections caused by Chlamydia, yet no significant clinical resistance has been reported for these obligate intracellular bacteria. Nevertheless, spontaneous AZM resistance (Azm(r)) arose in vitro at frequencies ranging from 3 x 10(-8) to 8 x 10(-10) for clonal isolates of Chlamydia caviae, which is a natural pathogen of guinea pigs. Sequencing of the unique 23S rRNA gene copy in 44 independent Azm(r) isolates identified single mutations at position A(2058) or A(2059) (Escherichia coli numbering system). While SP(6)AZ(1) (A(2058)C) and SP(6)AZ(2) (A(2059)C) Azm(r) mutants showed growth defects in cell culture and were less pathogenic in the guinea pig ocular infection model than in the parent SP(6), the three isogenic C. caviae isolates grew equally well in the animal. On the other hand, coinoculation of the C. caviae parent strain with one of the Azm(r) strains was detrimental for the mutant strain. This apparent lack of association between pathology and bacterial load in vivo showed that virulence of the two Azm(r) mutants of C. caviae was attenuated. While chlamydial growth in vitro reflects the ability of the bacteria to multiply in permissive cells, survival in the host is a balance between cellular multiplication and clearance by the host immune system. The obligate intracellular nature of Chlamydia may therefore limit emergence of resistance in vivo due to the strength of the immune response induced by the wild-type antibiotic-sensitive bacteria at the time of antibiotic treatment.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Cells, Cultured; Chlamydia; Chlamydia Infections; Conjunctivitis, Inclusion; Culture Media; Drug Resistance, Bacterial; Fibroblasts; Guinea Pigs; Mice; Microbial Sensitivity Tests; Mutation; Virulence

Trachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious cause of blindness. Sequence-based analysis of the multiple strains typically present in endemic communities may be informative for epidemiology, transmission, response to treatment, and understanding the host response.. Conjunctival and nasal samples from a Gambian community were evaluated before and 2 months after mass azithromycin treatment. Samples were tested for Ct by Amplicor, with infection load determined by quantitative PCR (qPCR). ompA sequences were determined and their diversity analysed using frequency-based tests of neutrality.. Ninety-five of 1,319 (7.2%) individuals from 14 villages were infected with Ct at baseline. Two genovars (A and B) and 10 distinct ompA genotypes were detected. Two genovar A variants (A1 and A2) accounted for most infections. There was an excess of rare ompA mutations, not sustained in the population. Post-treatment, 76 (5.7%) individuals had Ct infection with only three ompA genotypes present. In 12 of 14 villages, infection had cleared, while in two it increased, probably due to mass migration. Infection qPCR loads associated with infection were significantly greater for A1 than for A2. Seven individuals had concurrent ocular and nasal infection, with divergent genotypes in five.. The number of strains was substantially reduced after mass treatment. One common strain was associated with higher infection loads. Discordant genotypes in concurrent infection may indicate distinct infections at ocular and nasal sites. Population genetic analysis suggests the fleeting appearance of rare multiple ompA variants represents purifying selection rather than escape variants from immune pressure. Genotyping systems accessing extra-ompA variation may be more informative.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Outer Membrane Proteins; Base Sequence; Chlamydia trachomatis; Conjunctivitis, Inclusion; Genetic Variation; Genotype; Humans; Polymerase Chain Reaction; Trachoma

The World Health Organization recommends mass treatment of trachoma-hyperendemic communities, but there are scant empiric data on the number of rounds of treatment that are necessary for sustainable reductions. The rates of active trachoma and infection with C. trachomatis were determined in a community 3.5 years after two rounds of mass treatment with azithromycin.. Maindi village in Tanzania received a first round of mass treatment with azithromycin after a baseline survey for trachoma and infection. All residents aged 6 months and older were offered single-dose treatment with azithromycin (excluding pregnant women with no clinical trachoma, who were offered topical tetracycline). The residents were followed over an 18-month period, and, according to similar treatment criteria, were offered retreatment at 18 months. Five years after baseline (3.5 years after the second round of mass treatment), a new census and survey of current residents for trachoma and infection was conducted. Children are the sentinel markers of infection and trachoma in communities, so data are presented specifically for ages 0 to 7 years (preschool age) and 8 to 16 years.. Treatment coverage was above 80% for all ages in the first round, and highest (90%) in preschool-aged children. Second-round coverage was lower, <70%, and 70% in preschool-aged children. At 5 years, trachoma rates were still lower than baseline, ranging from 45% in those aged 0 to 3 years to 8% in those aged 11 to 15 years (compared with 81% and 39% at baseline, respectively). Infection rates at baseline ranged from 71% to 57%, but were 27% to 17% at 5 years after two rounds of mass treatment. At 5 years, there were no differences in trachoma or infection rates, when comparing new residents who came after the second mass treatment with those who had been resident in the village during both rounds (P > 0.05). Infection rates were lower in those who had been treated twice or at 18 months than in those treated only at baseline or never treated.. Although mass treatment appears to be associated with lower disease and infection rates in the long term, trachoma and C. trachomatis infection were not eliminated in this trachoma hyperendemic village 3.5 years after two rounds of mass treatment. Continued implementation of the SAFE strategy in this environment is needed.

Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Chlamydia trachomatis; Conjunctivitis, Inclusion; Endemic Diseases; Female; Humans; Infant; Male; Ophthalmic Solutions; Retreatment; Rural Population; Tanzania; Tetracycline; Trachoma

The majority of cases of chlamydial conjunctivitis are thought to result from autoinoculation by the patient of infected genital secretions from themselves or their sexual partners. We noted that some patients had developed symptoms following direct ejaculation into the affected eye. We describe four cases of chlamydial conjunctivitis following ejaculation of semen directly into the eye, which have not been previously described. In only one case was chlamydia detected in the genital tract. In three cases, there was no evidence of genital chlamydial infection; the sources of the eye infection being either from infected genital material of their sexual partners transferred by hands to the eyes, or more likely from direct ejaculate inoculation. It is likely that this mode of transmission is underestimated as a history of ejaculation into the conjunctiva is not normally asked for.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cervix Uteri; Chlamydia Infections; Chlamydia trachomatis; Ciprofloxacin; Conjunctivitis, Inclusion; Doxycycline; Ejaculation; Eye; Female; Homosexuality, Male; Humans; Male; Metronidazole; Neisseria gonorrhoeae; Risk Factors; Sexual Behavior; Sexual Partners; Treatment Outcome; Urethra; Urethritis

Mass antibiotic administrations for ocular chlamydial infection play a key role in the World Health Organization's trachoma control program. Mathematical models suggest that it is possible to eliminate trachoma locally with repeat mass treatment, depending on the coverage level of the population, frequency of mass treatments, and rate that infection returns into a community after each mass treatment. Precise estimates of this latter parameter have never been reported.. To determine the rate at which chlamydial infection returns to a population after mass treatment and to estimate the treatment frequency required for elimination of ocular chlamydia from a community.. Longitudinal cohort study of 24 randomly selected villages from the Gurage Zone in Ethiopia conducted February 2003 to October 2003. A total of 1332 children aged 1 to 5 years were monitored for prevalence of ocular chlamydial infection pretreatment and 2 and 6 months posttreatment.. All individuals older than 1 year were eligible for single-dose oral azithromycin treatment. Pregnant women were offered tetracycline eye ointment.. Prevalence of ocular chlamydial infection, measured by polymerase chain reaction, in children aged 1 to 5 years, in each of 24 villages at each time point was used to estimate the rate of return of infection and the treatment frequency necessary for elimination.. The prevalence of infection was 56.3% pretreatment (95% confidence interval [CI], 47.5%-65.1%), 6.7% 2 months posttreatment (95% CI, 4.2%-9.2%), and 11.0% 6 months posttreatment (95% CI, 7.3%-14.7%). Infection returned after treatment at an exponential rate of 12.3% per month (95% CI, 4.6%-19.9% per month). The minimum treatment frequency necessary for elimination was calculated to be once every 11.6 months (95% CI, 7.2-30.9 months), given a coverage level of 80%. Thus, biannual treatment, already being performed in some areas, was estimated to be more than frequent enough to eventually eliminate infection.. The rate at which ocular chlamydial infection returns to a community after mass treatment suggests that elimination of infection in a hyperendemic area is feasible with biannual mass antibiotic administrations and attainable coverage levels.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Child, Preschool; Chlamydia trachomatis; Conjunctivitis, Inclusion; Developing Countries; Ethiopia; Humans; Infant; Longitudinal Studies

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Child; Conjunctivitis, Inclusion; Drug Resistance, Microbial; Health Policy; Humans; Rural Health; Trachoma; Urban Health; World Health Organization

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Child; Conjunctivitis, Inclusion; Humans; Trachoma