Focus on update to trachoma treatment

Thousands of vulnerable people in remote Indigenous communities across the country are being unnecessarily mass-administered antibiotics under outdated treatment guidelines for trachoma.

An Aboriginal girl has the inside of her eyelid checked for any signs of infection by a doctor during trachoma screening at an outback community in WA. Picture: Chris Barry.

Thousands of vulnerable people in remote Aboriginal and Torres Strait Islander communities across the country are being unnecessarily mass-administered antibiotics under outdated treatment guidelines for the eye ­disease trachoma.

Groundbreaking Queensland research proves the disease – which Fred Hollows famously treated for years and is the world’s leading cause of preventable blindness – is less widespread than previously feared, and dosing entire communities with antibiotics is unneeded.

Trachoma is a bacterial eye infection that can cause irreversible blindness, and typically thrives in dry, dusty areas where it is difficult to maintain personal hygiene due to poverty and overcrowded households.

An ophthalmologist examines a child’s eye to check for signs of trachoma.

A new study, published in the Medical Journal of Australia, closely examined an unidentified remote community in northwest Queensland, previously thought to be home to endemic levels of trachoma.

Lead researcher Kate Lynch said current Australian guidelines required physical eye examinations of children aged between five and nine; if more than 5 per cent of the children show signs of the disease (typically dots on the upper eyelid) three rounds of antibiotics are administered to the whole community at 12-month intervals.

In the community, 695 eye examinations were done on people of all ages, with a focus on 171 children aged five to nine. More than 5 per cent of those children showed signs of trachoma, a threshold that would normally trigger community-wide antibiotics treatment.

But Ms Lynch, a PhD candidate with the University of Queensland Centre for Clinical Research and a Queensland Health nurse, said further examination by an ophthalmologist and PCR testing in a laboratory revealed very little evidence for current trachoma infections. Antibiotics for the whole community would have been unnecessary, she said.

“It’s getting harder in Australia to convince communities to take antibiotics; (the side-effects include) diarrhoea and nausea … and there’s always a risk of antibiotic resistance,” Ms Lynch said.

“What our research has shown is that our approach has worked in Queensland. In Australia, we need to change the way we diagnose trachoma, and monitor progress in the way we eliminate it. Australian national trachoma guidelines should be updated and should include laboratory testing.”

She said trachoma was strongly associated with poverty and “its persistence in First Nations communities is inextricably linked with social inequalities”.

As a result of the work of Ms Lynch and her fellow researchers, routine public health screening for trachoma is no longer required in Queensland.

An editorial published in the Medical Journal of Australia said the international and national guidelines for the treatment of trachoma should be reassessed.

John Kaldor, the head of global health at the University of New South Wales’ Kirby Institute – which publishes the annual Australian Trachoma Surveillance Report – was also involved in the Queensland study.

Professor Kaldor said community treatment with the antibiotic azithromycin had been highly effective in Australia and in many other countries in reducing the proportion of children with trachoma.

However, he added, “clearly the antibiotic approach is only part of the solution, which needs to involve addressing housing and other environmental factors that increase the risk of this preventable disease”.