Infectious Disease

Antibiotic Treatments (MDA)

At a Glance

Community-wide trachoma treatment usually uses a single, health-worker-directed dose of azithromycin, with children dosed by weight. Infants under 6 months and some people unable to take azithromycin may receive tetracycline eye ointment twice daily for six weeks.

The “A” in the SAFE strategy stands for Antibiotics, which are used to kill the bacteria (Chlamydia trachomatis) that cause trachoma ^[1]. Because the infection spreads so easily within families and neighborhoods, health programs treat eligible people in the entire community at once rather than just treating individuals who look sick ^[2].

This approach is called Mass Drug Administration (MDA). By giving medicine to everyone eligible at the same time, the program aims to drastically lower the amount of bacteria in the community and stop the cycle of re-infection ^[3].

When Community Treatment Happens

The World Health Organization (WHO) provides programmatic targets for annual MDA in areas where at least 5% of children aged 1 to 9 have signs of active infection (TF) ^[2]. The number of years the program continues depends on how common the infection is:

Low (5–9.9%): At least one round of treatment before re-checking ^[4].
Moderate (10–29.9%): At least three years of annual treatment ^[4].
High (30% or more): At least five years of annual treatment ^[4].

The coverage target is often to treat at least 80% of the people in the area to ensure the bacteria cannot easily find new hosts ^[2].

Standard Treatment: Oral Azithromycin

The preferred treatment is a single dose of azithromycin, an oral antibiotic. It is highly effective and stays in the body long enough to clear the infection with just one dose ^[5].

For Adults: Usually a standard maximum dose (typically 1 gram) ^[6].
For Children: The dose is strictly based on the child’s weight (20 mg per kilogram of body weight, up to the maximum dose) ^[6]. In many campaigns, health workers use height-measuring sticks to quickly determine the correct dose for children who can stand ^[7]. Children who are too small or fall below local weight or height thresholds are typically given the medicine as a liquid (oral suspension) ^[7]^[8].

Safety Warning: Never guess a dose, share tablets, or attempt to repeat a dose if you vomit; dosing must always be guided by the campaign health worker. Always tell the health worker if you have had a bad reaction to antibiotics in the past before taking the medicine ^[9].

Alternatives: Tetracycline Eye Ointment

Not everyone can take oral azithromycin. For specific groups, health programs provide 1% tetracycline eye ointment as an alternative ^[10].

Infants under 6 months: Routine campaigns usually do not give oral azithromycin to very young infants ^[11]. Instead, they may be prescribed tetracycline ointment ^[10].
Pregnant Women: Azithromycin is generally considered safe and compatible with pregnancy and breastfeeding in global guidelines, subject to local program rules ^[12]. Women who are pregnant or breastfeeding may take it, or may be offered the ointment based on local protocols ^[10].
Allergies: People who have a severe allergy to macrolide antibiotics (like erythromycin or azithromycin), or certain severe liver or heart conditions, should disclose this to the health worker, who will provide the ointment ^[10].

Important: Unlike the single-dose pill, the ointment must be applied to both eyes twice a day for six weeks ^[10]. Because this is a long time, many people find it difficult to finish the full course, but completing all six weeks is essential for the treatment to work ^[10].

What to Expect: Side Effects

Most people take these antibiotics without any serious problems ^[13]. However, mild side effects are common, especially with the oral tablets.

Common Reactions: About 1 in 10 people may experience mild stomach issues, including abdominal pain (stomach ache), nausea, vomiting, or diarrhea ^[14]^[13]. These symptoms are usually temporary and go away on their own.
Infants: In young children, parents may occasionally notice a mild rash or fussiness, but serious reactions are very rare in trachoma programs ^[15]^[16].

If someone in your family has a severe reaction—such as difficulty breathing or swelling of the face—seek medical help immediately.

Common questions in this guide

What is mass drug administration for trachoma?

Mass drug administration, or MDA, is a public-health approach in which eligible people in a community receive trachoma antibiotics at the same time. Treating the community lowers the amount of Chlamydia trachomatis bacteria and makes reinfection less likely, even when some people do not look sick.

How is the azithromycin dose chosen for a child?

For adults, programs usually use a dose up to 1 gram. For children, the health worker calculates 20 milligrams per kilogram of body weight, up to the maximum dose; height may be used in campaigns to estimate the dose. Do not guess, share tablets, or repeat a dose after vomiting without instructions from the health worker.

What treatment is used if someone cannot take azithromycin?

Infants younger than 6 months and people with a severe allergy to macrolide antibiotics or certain serious liver or heart conditions may be offered 1% tetracycline eye ointment instead. It is applied to both eyes twice daily for six weeks, exactly as the health worker demonstrates. The local program decides which option is appropriate.

Can I take trachoma antibiotics while pregnant or breastfeeding?

Global guidelines generally consider azithromycin compatible with pregnancy and breastfeeding, but local campaign rules may determine whether you receive tablets or ointment. Tell the health worker if you are pregnant or breastfeeding so they can recommend the appropriate option.

What side effects can happen after trachoma antibiotics?

Mild abdominal pain, nausea, vomiting, or diarrhea can occur after oral azithromycin and usually pass on their own. Young children may sometimes have a mild rash or fussiness. Get urgent medical help for trouble breathing or swelling of the face.

How long does community trachoma treatment last?

WHO program targets call for at least one treatment round when active trachoma affects 5–9.9% of children ages 1 to 9, at least three annual rounds at 10–29.9%, and at least five annual rounds at 30% or more. Local health authorities decide the schedule and reassess the community after treatment.

What should I do if someone vomits after treatment or we miss distribution day?

If someone vomits after taking an antibiotic or your family misses the distribution day, do not give another dose or use leftover medicine on your own. Contact the campaign health worker or local health program promptly for instructions. Seek urgent help for difficulty breathing or facial swelling.

Get notified when new evidence is published on trachoma.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References (16)

1
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Harding-Esch EM, Kadimpeul J, Sarr B, et al.
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PMID: 28747198
2
Population-based coverage survey results following the mass drug administration of azithromycin for the treatment of trachoma in Amhara, Ethiopia.
Astale T, Sata E, Zerihun M, et al.
PLoS neglected tropical diseases 2018; (12(2)):e0006270 doi:10.1371/journal.pntd.0006270.
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3
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PMID: 30698042
4
Epidemiology of trachoma and its implications for implementing the "SAFE" strategy in Somali Region, Ethiopia: results of 14 population-based prevalence surveys.
Duale AB, Negussu Ayele N, Macleod CK, et al.
Ophthalmic epidemiology 2018; (25(sup1)):25-32 doi:10.1080/09286586.2017.1409358.
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5
Childhood Mortality After Mass Distribution of Azithromycin: A Secondary Analysis of the PRET Cluster-randomized Trial in Niger.
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The Pediatric infectious disease journal 2018; (37(11)):1082-1086 doi:10.1097/INF.0000000000001992.
PMID: 29561511
6
Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genital Mycoplasma genitalium infection.
Harrison MA, Harding-Esch EM, Marks M, et al.
Sexually transmitted infections 2019; (95(7)):522-528 doi:10.1136/sextrans-2018-053938.
PMID: 30981999
7
Effect of Biannual Mass Azithromycin Distributions to Preschool-Aged Children on Trachoma Prevalence in Niger: A Cluster Randomized Clinical Trial.
Arzika AM, Mindo-Panusis D, Abdou A, et al.
JAMA network open 2022; (5(8)):e2228244 doi:10.1001/jamanetworkopen.2022.28244.
PMID: 35997979
8
Population-Based Prevalence of Ocular Chlamydia trachomatis Infection among Infants in the Trachoma Endemic Amhara Region, Ethiopia.
Nash SD, Chernet A, Astale T, et al.
The American journal of tropical medicine and hygiene 2021; (106(1)):62-65 doi:10.4269/ajtmh.21-0873.
PMID: 34695789
9
Treatment coverage of mass administration of azithromycin among children aged 1-11 months in 21 districts of Kebbi state, Nigeria.
Wamyil-Mshelia T, Madaki S, Isiyaku S, et al.
International health 2023; (15(15 Suppl 2)):ii12-ii18 doi:10.1093/inthealth/ihad086.
PMID: 38048379
10
Compliance with tetracycline eye ointment during annual mass drug administration for trachoma control in the Amhara region, Ethiopia.
Aragie S, Shiferaw A, Sata E, et al.
Tropical medicine & international health : TM & IH 2024; (29(10)):869-874 doi:10.1111/tmi.14042.
PMID: 39142662
11
Efficacy of mass drug administration with ivermectin for control of scabies and impetigo, with coadministration of azithromycin: a single-arm community intervention trial.
Romani L, Marks M, Sokana O, et al.
The Lancet. Infectious diseases 2019; (19(5)):510-518 doi:10.1016/S1473-3099(18)30790-4.
PMID: 30956111
12
In Defense of Mothers: Why Pregnant and Breastfeeding Women Should Be Included in Mass Drug Administration Programs.
Lord MG
Journal of women's health (2002) 2022; (31(9)):1219-1221 doi:10.1089/jwh.2022.0267.
PMID: 35944263
13
Antibiotics for trachoma.
Evans JR, Solomon AW, Kumar R, et al.
The Cochrane database of systematic reviews 2019; (9()):CD001860 doi:10.1002/14651858.CD001860.pub4.
PMID: 31554017
14
Self-Reported Side Effects following Mass Administration of Azithromycin to Eliminate Trachoma in Amhara, Ethiopia: Results from a Region-Wide Population-Based Survey.
Astale T, Sata E, Zerihun M, et al.
The American journal of tropical medicine and hygiene 2019; (100(3)):696-699 doi:10.4269/ajtmh.18-0781.
PMID: 30675840
15
Safety of azithromycin in infants under six months of age in Niger: A community randomized trial.
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16
Feasibility and acceptability of integrating mass distribution of azithromycin to children 1-11 months into a trachoma mass drug administration campaign to reduce child mortality in Côte d'Ivoire.
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PMID: 38985785

This page explains trachoma mass drug administration for informational purposes only and does not constitute medical advice. Follow local campaign instructions and ask a health worker about the correct medicine and dose for each person.

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