Randomised trial of community treatment with azithromycin and ivermectin mass drug administration for control of scabies and impetigo

Marks, Michael, Toloka, Hilary, Baker, Ciara, Kositz, Christian, Asugeni, James, Puiahi, Elliot, Asugeni, Rowena, Azzopardi, Kristy, Diau, Jason, Kaldor, John M., Romani, Lucia, Redman-MacLaren, Michelle, MacLaren, David, Solomon, Anthony W., Mabey, David C.W., and Steer, Andrew C. (2018) Randomised trial of community treatment with azithromycin and ivermectin mass drug administration for control of scabies and impetigo. Clinical Infectious Diseases. (In Press)

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Abstract

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.

Item ID: 54717
Item Type: Article (Research - C1)
ISSN: 1537-6591
Keywords: scabies; neglected tropical diseases; ivermectin; impetigo; antimicrobial resistance
Additional Information:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Funders: Wellcome Trust (WT)
Projects and Grants: WT clinical PhD fellowship 102807
Date Deposited: 24 Jul 2018 23:41
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111715 Pacific Peoples Health @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 100%
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