Antibiotic use in trachoma campaigns: height as proxy to weight in dosing of azithromycin in three Kenyan communities
Abstract
Background: Trachoma is the leading infectious cause of blindness with six out of 32 million
Kenyansat risk. It is endemic in 18 of the 73 districts in Kenya, with a total population of 6
million. The worst affected provinces are Rift Valley, Eastern and Northeastern. Current
trachoma control activities are limited to some districts in Kenya only, using the SAFE
strategy. This study was necessitated by the need to facilitate the implementation of the
'Antibiotic' part of the SAFE strategy to the affected communities during mass treatment.
Objective: To determine whether height can be used as an alternative to weight in dosing
azithromycin among children aged 1-15 years.
Methods: A community based cross sectional operational study was conducted in Kajiado,
Baringo and West Pokot districts. Children aged 1-15 years were randomly selected and
included in the study. Weight was measured using Salter digital scales and height was
determined using a height stick.A 250 mg tablet of azithromycin which could be divided in to
half to provide a dose of 125mg and 200mg / 5ml suspension was used to determine the doses
of azithromycin. Normal tolerance limit was defined as 15mg - 30 mg / kg body weight. The
data was entered into the computer and analyzed using the SPSS software package and
regression analysis was done where appropriate.
Results: A total of 2020 children were included. Of these 1033 (51.1%) were females and
987(48.9%) were males. Twenty five percent were in the age group ten to twelve. Generally,
children from West Pokot were heavier and taller than those from Kajiado and Baringo (P<
0.001)
Therewas a close relationship between weight and height and the distribution was near linear
withmostpoints clustering near the 45° line. Height explained 92.8% of the variance of weight
anddosage within tolerance limits could be predicted from height in 98.9% of the children. A
height based dose stick that recommends the use of suspension and 125mg (half tablet)
incremental,predicted doses within tolerance limits to 98.8% of children; while a height based
dosestick that encompasses suspension for children less than four years and 1 tablet (250mg)
incremental,predicted doses of97.5% of the children within tolerance levels.
Conclusion
A single height based dose stick can be used in the three Kenyan communities for the safe
administration of azithromycin during mass campaigns
Recommendations
Further studies should be carried out in other trachoma endemic districts in order to develop a
single model for height based dosage regime for the entire nation of Kenya. Manufacturers of
azithromycin should look into the possibility of manufacturing 125 mg tablet for trachoma
control purposes.
Citation
M.Med (Ophthalmology) ThesisSponsorhip
University of NairobiPublisher
Department of ophthalmology, University of Nairobi
Description
Master of Medicine