Safety, effectiveness, cost-effectiveness, acceptability and feasibility of co-administration of albendazole, diethylcarbamazine, ivermectin, and azithromycin: a systematic review

We synthesized evidence on the safety, effectiveness, cost-effectiveness, acceptability and feasibility of co-administering azithromycin with ivermectin, diethylcarbamazine and albendazole (IDA), or ivermectin and albendazole (IA), in areas co-endemic with lymphatic filariasis and either trachoma or yaws. A unified approach was defined as azithromycin co-administered with IA or IDA mass drug administration (MDA), while a staggered approach involved the separate administration of azithromycin 7–14 days after IA or IDA MDA. Of 201 records screened to compare a unified versus staggered approach for azithromycin and IDA, one cluster-randomised trial in Papua New Guinea met the inclusion criteria. Of 546 records screened to compare a unified versus staggered approach for azithromycin and IA, three studies met the inclusion criteria. Across studies, no severe adverse events were reported, though findings on adverse events were inconsistent. Coverage of azithromycin was lower in the staggered approach than the unified approach in two studies. One study found that the unified approach was broadly acceptable to communities and health workers. However, confidence in the evidence was limited by the small number of heterogeneous studies and inconsistent findings. Co-administration may offer operational and effectiveness advantages. Additional larger studies could strengthen the evidence base.