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Study of Azithromycin to Prevent Recurrent Trichiasis Following Surgery in Ethiopia (STAR)

This study has been completed.
National Eye Institute (NEI)
Project ORBIS
Information provided by (Responsible Party):
Sheila K West, Johns Hopkins University Identifier:
First received: July 3, 2006
Last updated: April 3, 2013
Last verified: April 2013
Trachoma, an ocular infection caused by C. trachomatis, is the second leading cause of blindness worldwide.Years of repeated infection with C. trachomatis cause the eyelid to scar and contract and ultimately to rotate inward such that eyelashes rub against the eyeball and abrade the cornea (trichiasis). The World Health Organization (WHO) has endorsed a multi-faceted strategy to combat trachoma, which includes surgery to correct trichiasis. Despite this encouraging news, under the best of circumstances the recurrence rate of trichiasis following surgery is disappointingly high. The objective of our project is to conduct a randomized, controlled clinical trial of post-surgical antibiotic treatment, comparing oral azithromycin to topical tetracycline, for trichiasis surgical patients in Ethiopia with the goal of determining the impact of treatment on rates of trichiasis recurrence at one and two years.

Condition Intervention Phase
Trichiasis Drug: azithromycin Drug: topical tetracycline Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Trial of Antibiotics to Reduce Recurrent Trichiasis (STAR)

Resource links provided by NLM:

Further study details as provided by Sheila K West, Johns Hopkins University:

Primary Outcome Measures:
  • recurrent trichiasis [ Time Frame: 1, 2, and 3-year follow-up ]
    clinical assessment of one or more eyelashes touching globe

Secondary Outcome Measures:
  • surgical failure [ Time Frame: 2 weeks ]
    clinical measure of one or more eyelashes touching globe

  • adverse events [ Time Frame: 4 weeks ]
    any report of hospitalization, death, or clinic visit within four weeks of receiving surgery

Estimated Enrollment: 1450
Study Start Date: August 2001
Study Completion Date: December 2006
Primary Completion Date: December 2003 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Control
topical tetracycline
Drug: topical tetracycline
Active Comparator: Intervention 1
oral azithromycin, single 1g dose to subject
Drug: azithromycin
oral antibiotic
Other Name: Zithromax
Active Comparator: Intervention 2
single oral asithromycin dose to subject and immediate family members
Drug: azithromycin
oral antibiotic
Other Name: Zithromax

Detailed Description:

A randomized clinical trial of the effectiveness of a single dose of azithromycin compared to 6 weeks of topical tetracycline, and the added benefit of family-based azithromycin treatment, in preventing recurrence of trichiasis following surgery is proposed. This will provide the evidence base to inform and change the global public health policy and the donation program policy, regarding post-surgical treatment for trichiasis patients and possibly their families.

The investigators will determine the impact of three treatment strategies following trichiasis surgery on the rate of trichiasis recurrence in the operated eye at six months and one year. A randomized clinical trial of 1425 trichiasis surgical patients will be conducted in Sodo,Ethiopia. The first group (Control Group) will receive topical tetracycline following surgery; the second group (Intervention Patient Group) will receive oral azithromycin; the third group (Intervention Family Group) will receive oral azithromycin, and all family members resident in the patient's household will also receive oral azithromycin. Data will be collected at baseline (pre-surgery) on ocular status and infection status. Data will be collected at the time of surgery on surgery-related variables and surgical and post-operative complications. Additional data will be collected on any surgical complications and early recurrence at the two-week visit when sutures will be removed. A follow up visit at two months will include data collection on recurrence and presence of ocular infection. Evaluations for trichiasis recurrence will occur again at six months and at one year post-surgery. The latter visit will also include data collection on presence of ocular infection in the surgical case, and ocular infection in household members. Evaluation of the risk of recurrence at six months and one, two, and three years within each group will be completed to determine the benefit of using azithromycin compared to topical tetracycline, and the added benefit of family-based treatment.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Presence of trichiasis:
  • no previous report of trichiasis surgery in at least one eye with trichiasis:
  • Agreement by at least one other family member accompanying the patient that, if the patient is randomized to the family-treatment arm, s/he also would be willing to receive antibiotic treatment
  • Age 18 or older

Exclusion Criteria:

  • other household members concurrently participating in the trial
  • Self-reported pregnancy
  • Documented allergy to tetracycline
  • Plans to move out of the region within 1 year.
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Please refer to this study by its identifier: NCT00347776

United States, Maryland
Johns Hopkins University
Baltimore, Maryland, United States, 21205
Sponsors and Collaborators
Johns Hopkins University
National Eye Institute (NEI)
Project ORBIS
Principal Investigator: Sheila K West Johns Hopkins University
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Sheila K West, Professor, Johns Hopkins University Identifier: NCT00347776     History of Changes
Other Study ID Numbers: U01EY013878 ( U.S. NIH Grant/Contract )
Study First Received: July 3, 2006
Last Updated: April 3, 2013

Keywords provided by Sheila K West, Johns Hopkins University:
trichiasis surgery
topical tetracycline

Additional relevant MeSH terms:
Eyelid Diseases
Eye Diseases
Anti-Bacterial Agents
Anti-Infective Agents
Protein Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action processed this record on July 27, 2017