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To the Editor: In their study of targeted trachoma treatment, Dr Atik and associates¹ describe the effect of selective antibiotic treatment of trachoma in Vietnamese communes with low rates of active trachoma. They conclude that targeted treatment of school children with disease (and their families) may interfere with the development of protective immunity and lead to increasing infection rates. We feel these conclusions are not justified because of the inherent difficulties in studying trachoma treatment of communities with a low prevalence (<5%) of active disease in young children.

Antibiotic treatment limited to school children has not been effective elsewhere. For example, antibiotic treatment of school children in Tunisia did not affect the prevalence of trachoma in 1- to 10-year-olds over a 3-year period.² In communities with hyperendemic trachoma, the highest prevalence of disease and infection are in preschool children, chlamydial eye infection is widely distributed, and there is a correlation . . . [Full Text of this Article]

Chandler R. Dawson, MD
Chandler.Dawson@ucsf.edu

Julius Schachter, PhD
University of California, San Francisco