Title

Azithromycin - Ivermectin Mass Drug Administration for Skin Disease
Impact of Combined Azithromycin and Ivermectin Mass Drug Administration for Yaws and Scabies - Impact on Impetigo and Skin Microbiology
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Study Participants

    1291
This is an open-label prospective community intervention trial to assess the impact of community mass treatment with azithromycin for yaws and ivermectin for scabies, on non-yaws bacterial skin infections.

Communities will be randomised to receive standard treatment for both yaws and scabies either in parallel (site 1) or in sequence (site 2).

Treatment of yaws:

Single dose of Azithromycin (30mg/kg, max 2G).

Treatment of scabies:

Either an oral dose of Ivermectin (200μg/kg) or permethrin cream for those with a contraindication to Ivermectin (WT<15kg, pregnant or breastfeeding women) given in 2 doses 7-14 days apart.

Investigators will complete a clinical and microbiological assessment of bacterial skin disease at baseline and at 12 months to assess the impact of treatment on the prevalence of bacterial infection and the emergence of antimicrobial resistance.

Primary Outcome

Difference in the change in prevalence of impetigo between baseline and 12- months between the parallel and the sequential treatment arms.

Secondary Outcomes

Change in the proportion of swab samples from which S. pyogenes is cultured between baseline and follow-up in the two arms
The proportion of samples from which a drug-resistant isolate of S.pyogenes is cultured in the two arms
Study Started
Jul 31
2016
Primary Completion
Aug 31
2017
Study Completion
Feb 05
2018
Results Posted
Sep 13
2019
Last Update
Sep 17
2019

Drug Ivermectin

Participants will be offered treatment for both yaws and scabies either in parallel or in sequence. Ivermectin will be offered as a a single dose 200μg/kg on Day 1 and Day 8.

Drug Azithromycin

Participants will be offered treatment for both yaws and scabies either in parallel or in sequence. Azithromycin will be offered as single dose of 30mg/kg, max 2G.

Drug Permethrin

Participants will be offered treatment for both yaws and scabies either in parallel or in sequence. Individuals with a contra-indication to ivermectin will be offered Permethrin instead.

Parallel Treatment Other

Site 1- Parallel Treatment Arm Single dose azithromycin (for yaws) and Ivermectin/Permethrin (for scabies) will be offered on D1. A second dose of Ivermectin/Permethrin will be offered 7-14 days later.

Sequential Treatment Other

Site 2- Serial Treatment Arm Ivermectin/Permethrin (for scabies) will be offered on D1 with a second dose of Ivermectin/Permethrin offered 7-14 days later.. Single dose azithromycin (for yaws) will be offered at the twelve month follow-up visit.

Criteria

Inclusion Criteria:

All community members are able to be included in the study.

Exclusion Criteria:

Allergy to any of the components of the allocated drug regimen

Summary

Parallel Treatment

Sequential Treatment

All Events

Event Type Organ System Event Term

Impetigo Prevalence at 12 Months

Change in prevalence of impetigo between baseline and 12-months

Parallel Treatment

Cases Impetigo at 12 Months

20.0
Cases of impetigo

Cases Impetigo at Baseline

79.0
Cases of impetigo

Sequential Treatment

Cases Impetigo at 12 Months

12.0
Cases of impetigo

Cases Impetigo at Baseline

66.0
Cases of impetigo

Group A Streptococcus at 12 Months

Change in the percentage of swab samples from which S. pyogenes is cultured between baseline and 12 month follow-up in the two arms

Parallel Treatment

Swabs containing S.pyogenes at 12 months

4.0
Change in number swabs with S.pyogenes

Swabs containing S.pyogenes at baseline

17.0
Change in number swabs with S.pyogenes

Sequential Treatment

Swabs containing S.pyogenes at 12 months

1.0
Change in number swabs with S.pyogenes

Swabs containing S.pyogenes at baseline

28.0
Change in number swabs with S.pyogenes

Antimicrobial Resistance in Culture Isolates

The proportion of samples from which a drug-resistant isolate of S.pyogenes is cultured in the two arms

Parallel Treatment

% Swabs with resistance at 12 months

% Swabs with resistance at baseline

Sequential Treatment

% Swabs with resistance at 12 months

% Swabs with resistance at baseline

Total

1291
Participants

Age, Continuous

25
years (Median)
Inter-Quartile Range: 10.0 to 47.0

Race (NIH/OMB)

Region of Enrollment

Sex: Female, Male

Overall Study

Parallel Treatment

Sequential Treatment