Topical therapy of hyperendemic trachoma with rifampicin, oxytetracycline, or spiramycin eye ointments.

A double-blind stratified treatment trial was carried out on 108 patients with moderate to severe trachoma in a village in Southern Iran to assess the efficacy of topical therapy of I % rifampicin eye ointment or 1% spiramycin eye ointment in comparison with 1% oxytetracycline eye ointment. A 6-week course of treatment with the antibiotics used twice daily produced a cure rate of 67 % for rifampicin, 56% for oxytetracycline, and 64% for spiramycin when the upper tarsal conjunctiva was examined 1 week after completion of treatment. Seven months later the number of patients still free from active trachoma was reduced considerably. When the whole conjunctiva was examined, the cure rate for all 3 antibiotics was considerably lower than that obtained by examining the upper tarsus alone. The marked difference in response to treatment between the upper tarsus and the whole conjunctiva was due mainly to the presence of residual mild trachomatous inflammation in the upper fornix and the lower lid conjunctiva. The follow-up investigations revealed that this residual inflammation in the upper fornix and the lower lid is related to an increased risk of recurrence of inflammation in the whole conjunctiva, including the upper tarsal area. Microbiologically, after treatment with the antibiotics the isolation rate fell from 18-19% to 2-4%. Seven months later the isolation rate in the group treated with rifampicin or oxytetracycline remained low, whereas in the group treated with spiramycin this was raised to a level of 27 %. The result of this study indicates that under field conditions topical chemotherapy with rifampicin