Trachoma and antibiotic use: the 'A' in SAFE

Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. In recognition of this public health problem, the World Health Assembly has targeted the year 2020 to eliminate blinding trachoma, and a multifaceted strategy (SAFE) is recommended, including antibiotics for treatment of infection. Trachoma is a disease of entire communities, and the pool of infection resides largely in preschool age children. Thus, for endemic communities, mass treatment with antibiotics annually for at least 3-5 years is carried out. The antibiotics used, the effectiveness of this approach, and the challenges of antibiotic treatment of communities are discussed, concluding with a view towards the elimination of trachoma in the future.