A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae

Amanda J. Leach, Tania M. Shelby-James, Mark Mayo, Mike Gratten, Andrew C. Laming, Bart J. Currie, John D. Mathews

Research output: Contribution to journalArticlepeer-review

197 Citations (Scopus)

Abstract

In February 1995, single-dose azithromycin was given to children with trachoma and their household contacts who were children. For children with trachoma, rates of carriage of pneumococci immediately before treatment with azithromycin and 2-3 weeks, 2 months, and 6 months after treatment were 68% (54 of 79), 29% (11 of 38), 78% (29 of 37), and 87% (34 of 39), respectively. The proportion of carriage-positive children with azithromycin-resistant Streptococcus pneumoniae strains was 1 of 54 (1.9%) before treatment and then 6 of 11 (54.5%), 10 of 29 (34.5%), and 2 of 34 (5.9%) at follow-up visits. The profile of pneumococcal serotypes changed after azithromycin treatment. Azithromycin-resistant strains (serotypes 10F, 23A, and 45) were isolated from 1 (1.3%) of 79 pretreatment swab specimens, from 16 (21.3%) of 75 swab specimens collected up to 2 months after treatment, and from 2 (6%) of 32 obtained 6 months after treatment. Mathematical modeling showed a more rapid appearance of azithromycin-resistant pneumococcal strains in previously colonized children than in previously noncolonized children. Thus, it appears that the selective effect of azithromycin allowed the growth and transmission of preexisting azithromycin-resistant strains. More research is needed to clarify the clinical relevance and implications of azithromycin use.

Original languageEnglish
Pages (from-to)356-362
Number of pages7
JournalClinical Infectious Diseases
Volume24
Issue number3
DOIs
Publication statusPublished - Mar 1997
Externally publishedYes

Bibliographical note

Funding Information:
Financial support: Northern Territory Government, Public Health Research, and Development Committee of the National Health and Medical Research Council.

Funding Information:
Written informed consent was obtained from parents or guardians. The study was approved by an Institutional Ethics Committee with Aboriginal representation, working with Australian National Health and Medical Research Council guidelines.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

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