A Cochrane review included 14 individual-based studies, with a total of 3 587 subjects, and 8 community-based studies (67 communities). Any antibiotic treatment on active trachoma was apparently more effective than control at 3 months (9 trials, n=1 961; pooled risk ratio 0.78; 95% CI 0.69 to 0.89) as well as at 12 months (4 trials, n=1 035; pooled risk ratio 0.74; 95% CI 0.55 to 1.00). There was considerable heterogeneity between trials. The effect of any antibiotic treatment on ocular C. trachomatis infection appeared to be of a similar order but did not achieve statistical significance (4 trials, n=297, pooled risk ratio 0.81; 95% CI 0.63 to 1.04). The comparison of oral versus topical antibiotic on active trachoma showed no significant difference (6 trials, n=953). The exclusion of one trial that used unsupervised topical treatments substantially reduced the observed inconsistency between studies, resulting in a pooled risk ratio for the remaining 5 trials of 1.04 (95% CI 0.94 to 1.16) at 3 months and 1.01 (95% CI 0.85 to 1.20) at 12 months, respectively.
There was evidence that community-based antibiotic treatment reduced the prevalence of active trachoma and ocular infection 12 months after single-dose treatment. There was some evidence that oral azithromycin was more effective than topical tetracycline as a community treatment.
Comment: The quality of evidence is downgraded by limitations in study quality (inadequate or unclear allocation concealment) and by inconsistency (variability in results across studies).