**6.2 Antibiotics**

The WHO recommends mass distribution of antibiotics in communities where follicular trachoma is >10% in children [12]. In 1940, sulfonamide was the first antibiotic to be used at a large scale to treat trachoma. Over the ensuing decades, several other antibiotics were evaluated with little success until in 1990 when tetracycline became the drug of choice.

In more recent decades, azithromycin has been adopted as the drug of choice by many trachoma control programs because of its many advantages over tetracycline ointment [51]. For example, azithromycin is a single-dose regime and treatment can be directly observed to improve compliance significantly.

The WHO has developed guidelines for determining how community treatment of trachoma based solely on the prevalence of trachoma follicles in children aged 1–9 (**Figure 2**) [52]. It is recommended that trachoma control programs use either 6 weeks' regimen of tetracycline eye ointment instilled into the lower conjunctival sacs two times a day or a single dose of azithromycin (20 mg/kg up to 1 g) [53, 54]. The duration of treatment remains a subject of debate and further research. The WHO recommends three annual rounds of mass treatment endemic communities after which a reassessment of active disease will determine whether another round of treatment will be needed or discontinued [55].
