A Prospective Study of the Impact of Community-Based Azithromycin Treatment of Trachoma on Carriage and Resistance of Streptococcus pneumoniae

Leach, Amanda J.; Shelby‐James, Tania; Mayo, Mark; Gratten, M; Laming, A C; Currie, Bart J.; Mathews, John D.

doi:10.1093/clinids/24.3.356

Cited by 226 publications

(164 citation statements)

References 17 publications

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“…This phenomenon occurred both in the crèche and in the orphanage facilities in this study, where the spread of two unrelated pneumococcal clones clearly correlated with prior treatment with ␤-lactams. Similar associations were reported by other researchers in relation to macrolides and trimethoprim-sulfamethoxazole (1,19). In this study, these antimicrobial agents were prescribed only occasionally in both centers.…”

Section: Discussionsupporting

confidence: 91%

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

et al. 2004

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Nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in 226 children in different settings (in a crèche [day care center], in an orphanage, and at home) during two seasons (winter and spring) was studied. The rates of carriage of S. pneumoniae and H. influenzae were markedly higher in the crèche and in the orphanage than in the home setting (e.g., 56.5, 63.3, and 25.9%, respectively, for S. pneumoniae in winter). Approximately 80% of the S. pneumoniae isolates identified in the crèche and in the orphanage belonged to the serotypes represented in the seven-valent pneumococcal vaccine, and 4.4% of the children were colonized by H. influenzae type b. Almost all H. influenzae isolates were fully susceptible to the antimicrobial agents tested, and only five (3.6%) produced ␤-lactamase; in contrast, 100% of the M. catarrhalis isolates were ␤-lactamase positive. Among S. pneumoniae isolates, 36.2% were nonsusceptible to penicillin (PNSP) and 11.8% were fully resistant to penicillin (PRP). All PNSP isolates were obtained from children at the crèche and at the orphanage but not among children brought up at home, and all PRP isolates showed a multiresistant phenotype. Colonization by PRP isolates correlated well with prior treatment with ␤-lactams. For the majority of children colonized at both sampling times, strain replacement of S. pneumoniae and H. influenzae was observed; long-term colonization by a single strain was rare.The nasopharynx of children is colonized by a broad variety of microorganisms, including such potential pathogens as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Well-known risk factors that promote bacterial carriage include overcrowding, e.g., due to attending day care centers (DCCs) (crèches) or residing in orphanages; frequent viral infections; and an excessive use of antibiotics (12). DCCs and orphanages have also been identified as places that promote the clonal spread of multiresistant strains; thus, healthy children represent an important reservoir of bacterial strains, in particular, S. pneumoniae, that are resistant to many antimicrobial agents. These strains are subsequently disseminated in the community by other contacts of colonized children, e.g., their siblings and parents. It is possible to limit the spread of H. influenzae type b and some serotypes of S. pneumoniae by vaccination, but studies of the impact of immunization on colonization have yielded discrepant results (5,11,14,22).Colonization of mucosal surfaces in the human respiratory tract represents a dynamic process in which bacteria are acquired, eliminated, and reacquired many times in a lifetime. Extensive and often excessive use of antibiotics can promote the replacement of strains susceptible to antimicrobial agents by resistant ones (12, 28). Moreover, the human nasopharynx is also often viewed as a place where frequent genetic exchange takes place due to such processes as transformation with foreign DNA, bacterial intra-and interspecies c...

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Section: Discussionsupporting

confidence: 91%

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

et al. 2004

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“…The absence of azithromycin resistance at the first cross-sectional survey is consistent with previous studies carried out in Australia, Nepal and the United Republic of Tanzania, all of which showed that substantial azithromycin resistance did not develop following a single treatment dose in areas where the baseline prevalence of the carriage of resistant strains was low. [23][24][25] The prevalence of the carriage of azithromycin-resistant pneumococci rose to just over 1% at the second cross-sectional survey. However, at the third survey, there was no significant difference in prevalence between villages that received three annual MDA rounds and those that received one.…”

Section: Discussionmentioning

confidence: 99%

Mass administration of azithromycin andStreptococcus pneumoniaecarriage: cross-sectional surveys in the Gambia

Burr

Milne

Jafali

et al. 2014

Bull. World Health Organ.

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“…Evidence from studies conducted prior to 2001, which were conducted in populations with little exposure to azithromycin, describe temporary increases in the prevalence of antimicrobial drug-resistant Streptococcus pneumoniae carriage in treated children. 20,[25][26][27] No drug-resistant isolates were detected * Adjusted for effects of child's age < 2 years at enrollment, presence of a toilet in the household, and antibiotic treatment of acute lower respiratory illness during follow-up period. Standard errors corrected for clustering.…”

Section: Discussionmentioning

confidence: 99%

Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

Coles

Seidman

Levens

et al. 2011

The American Society of Tropical Medicine and Hygiene

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A cohort study was designed to assess the impact of mass distribution of azithromycin (MDA) for trachoma control on incidence over six months of pediatric diarrhea in eight communities in rural Tanzania. A single dose of azithromycin was offered to all residents in four communities, where trachoma prevalence was ≥ 10%. Four geographically matched communities had trachoma prevalences < 10% and did not receive MDA. All randomly selected children (n = 1036) were followed-up for six months post-MDA with bi-weekly surveillance at home. In the 0–1-month and 1–3-month periods, MDA exposure was associated with a 39% (rate ratio = 0.61, 95% confidence interval = 0.39–0.95) and 24% (rate ratio = 0.76, 95% confidence interval = 0.54–1.07) lower risk of diarrhea, respectively, compared with those unexposed, after adjustment for clustering and covariates. By the 3–6-month period, diarrhea incidence was comparable between groups. Thus, MDA was associated with a short-term reduction in diarrheal morbidity in children.

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A Prospective Study of the Impact of Community-Based Azithromycin Treatment of Trachoma on Carriage and Resistance of Streptococcus pneumoniae

Cited by 226 publications

References 17 publications

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

Mass administration of azithromycin andStreptococcus pneumoniaecarriage: cross-sectional surveys in the Gambia

Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

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