This article is more than 5 years old. Information may no longer be current.

Single-dose azithromycin easily administered vs. standard therapy for yaws

Mitjà O. Lancet. 2012;doi:10.1016/S0140-6736(11)61624-3.

New findings published in The Lancet indicate that a single oral dose of azithromycin was noninferior to the standard benzathine benzylpenicillin treatment for yaws disease and did not require injection equipment or medically trained personnel.

“A change to the simpler azithromycin treatment regimen could enable yaws elimination through mass drug administration programs,” according to Oriol Mitjà, MD, of the Lihir Medical Center in Papua New Guinea, and colleagues.

Between Sept. 1, 2010, and Feb. 1, 2011, the researchers conducted an open-label, noninferiority trial to assess the efficacy of azithromycin compared with intramuscular long-acting penicillin to treat children aged 6 months to 15 years diagnosed with yaws in Papua New Guinea.

Participants were randomly assigned to either one 30 mg/kg oral dose of azithromycin (n=124) or an intramuscular injection of 50,000 U/kg benzathine benzylpenicillin as controls (n=126).

At 6 months, researchers found that 96% of patients in the azithromycin group were cured vs. 93% of patients in the benzathine benzylpenicillin group (95% CI, –9.3 to 2.4). In addition, both treatment groups had similar mild to moderate drug-related adverse events.

“With yaws re-emerging, treatment with an effective drug that can be easily administered on a large scale is the preferred method for treatment, prevention and, eventually, elimination worldwide,” the researchers wrote. “Elimination programs need to take account of all epidemiological, biological and pharmacological factors, and the practical considerations of a mass campaign to deliver and administer drugs in isolated and under-resourced communities.”

Disclosure: This research was funded by International SOS and Newcrest Mining.

This is an important study showing that a single oral dose of azithromycin, 30 mg/kg, was noninferior to 50,000 units of benzathine penicillin given intramuscularly for the treatment of yaws in children. The advantages of oral dosing over intramuscular dosing are obvious and avoid the risk of an immediate reaction to the penicillin. Confirmatory studies are under way, and if supported, then oral azithromycin could become the approach of choice for treating yaws in children. The potential downside is also obvious; the selection of macrolide-resistant strains of the causative bacterium would have to be monitored if the use of azithromycin becomes more widespread.

Lowell S. Young, MD
Kuzell Institute for Arthritis and Infectious Disease
San Francisco, Calif.

Disclosure: Dr. Young reports no relevant financial disclosures.

Follow the PediatricSuperSite.com on Twitter.