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If the baseline district prevalence of TF in 1–9-year-old children is 10% or greater, antibiotic treatment of all residents should be undertaken annually for 3 years. After these three treatments, a repeat district survey should be carried out. If the district prevalence of TF in 1–9-year-old children is still 10% or greater, annual mass treatment should be continued. If the prevalence is less than 10%, surveys should be conducted to determine the prevalence at community level. Then, in communities in which the prevalence is less than 5%, treatment can be stopped; and in communities in which the prevalence is 5% or greater, annual treatment should continue until such time as it falls below 5%.
WHO currently recommends two antibiotics for the control of trachoma: 1% tetracycline eye ointment and azithromycin. Tetracycline eye ointment can clear ocular C. trachomatis infection if administered to both eyes twice daily for 6 weeks, and is almost universally available. It is, however, difficult and unpleasant to apply, so compliance is often poor. Azithromycin clears ocular C. trachomatis infection with one oral dose (20 mg/kg body weight) and is well tolerated by both children and adults, but is relatively expensive. If azithromycin is available, trachoma control programmes are encouraged to choose it as their first-line antibiotic, with small quantities of tetracycline eye ointment for children under 6 months of age. If azithromycin is not available to the programme, tetracycline eye ointment should be offered to all persons who need antibiotics.
