Three rounds of Antibiotic Therapy Superior to Targeted Treatment for Reducing Yaws in Cases

(Reuters Health) The administration of three rounds at six-month intervals of azithromycin was four times more effective than one treatment. This is according to information from more than 56,000 children living in Papua New Guinea.

The World Health Organization aims to remove skin disfigurement and long bone infection by 2030.

“Our intervention resulted in a tremendous reduction in the prevalence of the disease,” team leader Dr. Oriol Mitja told Reuters Health in an email.

The cluster-randomized study, published in The New England Journal of Medicine was conducted out of the concern that the current treatment strategy that includes targeted treatment “which is focused on people who have active infection and their contact, may not achieve a sufficient amount of coverage for those with latent infections,” said the study team.

They utilized one of the two strategies in 38 regions.

Before treatment, the prevalence of active yaws was 0.43% in the group that was destined to get three treatments and 0.46 percent with conventional therapy.

After 18 months after 18 months, the rates were 0.04% and 0.16 percent, respectively.

Researchers estimated that 100 doses of azithromycin were required for each latent yaws that were observed among the children.

“Despite this accomplishment, eradication per se was not attained,” said Dr. Mitja Dr. Mitja, an infectious diseases researcher at the Hospital Germans Trias i Pujol in Barcelona. “Efforts must be maintained until the goal is reached.”

Children between 6 and 10 years old were especially susceptible to the disease’s return.

Dr. Mitja stated that the reason for the intervention’s failure to complete elimination is not clear. It could be due to a spillover from the areas of the control group to the experimental group, insufficient cases being treated, or missed active cases.

“It is very difficult to reach all the people living in an area that is endemic due to the absence of official censuses. This can result in some being left behind unintentionally.” He added. “Also many of these populations live off an informal economy which might involve frequent travel (for selling goods for daily survival, for example) This further hinders the capacity of reaching the whole of the population when using a mass drug administration.”

The cost of both interventions is comparable, said Dr. Mitja.

There were only three cases of antibiotic resistance, and these patients were successfully treated using penicillin that can be injected.

“The appearance of azithromycin-resistant cases is a heads up on the need to perform continuous monitoring for antibiotic resistance for early identification and stopping the spread,” Dr. Mitja said.

He said, “We are one step closer to the eradication an infectious disease, which is the second in history after smallpox.” “The development and implementation of strategies to eradicate the disease is essential for other infectious diseases, which is vital for humanity’s future well-being.” It is probable that new infections will develop in the near future, some more dangerous than Covid-19. Therefore, research is needed to eliminate and control these diseases.

SOURCE: https://bit.ly/3eE1i0j The New England Journal of Medicine, online January 5, 2022.