Impact of Azithromycin Administration for Trachoma Control on the Carriage of Antibiotic-Resistant Streptococcus pneumoniae

ABSTRACT Community distribution of azithromycin has an important role to play in trachoma control. Previous studies have suggested that this may increase the prevalence of macrolide-resistant Streptococcus pneumoniae. S. pneumoniae was isolated from children under 7 years of age in Rombo District, northern Tanzania, before and 2 and 6 months after community-wide administration of azithromycin. Overall carriage rates were 11, 12, and 7%, respectively. Only one macrolide-resistant isolate carrying the mef gene was obtained 6 months after azithromycin administration. This contrasted with cotrimoxazole and penicillin resistance, both of which were common (cotrimoxazole resistance, 42, 43, and 47%, and penicillin resistance, 21, 17, and 16% at baseline, 2 months, and 6 months, respectively). There was a significant association between cotrimoxazole and penicillin resistance (P < 0.0001, Fisher's exact). These data suggest that in communities where macrolide resistance is rare, azithromycin distribution for trachoma control is unlikely to increase the prevalence of resistant organisms.

[1]  A. Schuchat,et al.  Adverse and beneficial secondary effects of mass treatment with azithromycin to eliminate blindness due to trachoma in Nepal. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  M. Leinonen,et al.  Ribosomal Mutations in Streptococcus pneumoniae Clinical Isolates , 2002, Antimicrobial Agents and Chemotherapy.

[3]  D. Musher,et al.  Emergence of macrolide resistance during treatment of pneumococcal pneumonia. , 2002, The New England journal of medicine.

[4]  K. Tateda,et al.  High frequency of erythromycin A resistance and distribution of mefE and ermB genes in clinical isolates of Streptococcus pneumoniae in Japan , 2002, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy.

[5]  M. Joloba,et al.  High prevalence of carriage of antibiotic-resistant Streptococcus pneumoniae in children in Kampala Uganda. , 2001, International journal of antimicrobial agents.

[6]  George M. Carlone,et al.  Evaluation of a Medium (STGG) for Transport and Optimal Recovery of Streptococcus pneumoniae from Nasopharyngeal Secretions Collected during Field Studies , 2001, Journal of Clinical Microbiology.

[7]  G. Johnson,et al.  Operational comparison of single-dose azithromycin and topical tetracycline for trachoma. , 2000, Investigative ophthalmology & visual science.

[8]  G. Mccracken,et al.  Effects of amoxicillin/clavulanate or azithromycin on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis media. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  K. O'Brien,et al.  Impact of azithromycin on oropharyngeal carriage of group A Streptococcus and nasopharyngeal carriage of macrolide-resistant Streptococcus pneumoniae. , 2000, The Pediatric infectious disease journal.

[10]  K. Klugman,et al.  Trends in antimicrobial resistance and serotype distribution of blood and cerebrospinal fluid isolates of Streptococcus pneumoniae in South Africa, 1991-1998. , 2000, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[11]  J. Whitcher,et al.  Alterations in the conjunctival bacterial flora following a single dose of azithromycin in a trachoma endemic area , 1999, The British journal of ophthalmology.

[12]  R. Bailey,et al.  Eradication of trachoma worldwide , 1999, The British journal of ophthalmology.

[13]  T. Quinn,et al.  Azithromycin in control of trachoma , 1999, The Lancet.

[14]  J. Karon,et al.  Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial , 1999, The Lancet.

[15]  B. Greenwood,et al.  The epidemiology of pneumococcal infection in children in the developing world. , 1999, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[16]  H. Sørensen,et al.  Risk of resistance related to antibiotic use before admission in patients with community-acquired bacteraemia. , 1999, The Journal of antimicrobial chemotherapy.

[17]  P Huovinen,et al.  The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. , 1997, The New England journal of medicine.

[18]  R. Rubinstein,et al.  A comparison of oral azithromycin with topical oxytetracycline/polymyxin for the treatment of trachoma in children. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  J. Mathews,et al.  A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  G. Stefánsdóttir,et al.  Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study , 1996, BMJ.

[21]  J. Paul,et al.  Serotypes and antibiotic susceptibilities of Streptococcus pneumoniae in Nairobi, Kenya. , 1996, The Journal of infection.

[22]  R. Adegbola,et al.  Effect of azithromycin on pharyngeal microflora. , 1995, The Pediatric infectious disease journal.

[23]  H. Whittle,et al.  Randomised controlled trial of single-dose azithromycin in treatment of trachoma , 1993, The Lancet.

[24]  J. Henrichsen.  The pneumococcal typing system and pneumococcal surveillance , 1979 .