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Research Letter
May 13, 2013

Adult Mortality in a Randomized Trial of Mass Azithromycin for Trachoma

Author Affiliations

Author Affiliations: Francis I. Proctor Foundation (Drs Keenan, Gaynor, Porco, and Lietman), Department of Ophthalmology (Drs Keenan, Gaynor, Porco, and Lietman), Department of Epidemiology and Biostatistics (Drs Porco and Lietman), and Institute for Global Health (Dr Lietman), University of California, San Francisco; and the Carter Center, Atlanta, Georgia (Dr Emerson).

JAMA Intern Med. 2013;173(9):821-823. doi:10.1001/jamainternmed.2013.3041

Annual mass azithromycin treatments are provided to entire communities to clear the ocular strains of Chlamydiatrachomatis that cause blinding trachoma. Mass treatments reduce the community burden of ocular chlamydia and have proven efficacious in community-randomized trials.1 Since 1999, more than 150 million doses of azithromycin have been distributed for trachoma worldwide.2

Mass azithromycin distributions are directed at clearing ocular chlamydia but may have other effects. For example, in the Trachoma Amelioration in Northern Amhara (TANA) trial, we found that mass azithromycin distributions reduced childhood mortality.3 In contrast, a recent observational study suggested that azithromycin use may cause sudden death in adults.4 This finding could have major implications for trachoma elimination efforts. In our previous report, an intention-to-treat analysis found no evidence of increased mortality among individuals older than 9 years.3 However, in light of the recent observational study, we thought it worthwhile to reassess our data to determine the mortality rates and causes of death in an older subgroup of individuals and to compare mortality in individuals who received azithromycin with that in those who did not.