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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antibiotic selection pressure and macrolide resistance in Nasopharyngeal Streptococcus pneumoniae: A cluster-randomized clinical trial
PLoS Medicine, Volume 7, No. 12, Article e1000377, Year 2010
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Description
Background: It is widely thought that widespread antibiotic use selects for community antibiotic resistance, though this has been difficult to prove in the setting of a community-randomized clinical trial. In this study, we used a randomized clinical trial design to assess whether macrolide resistance was higher in communities treated with mass azithromycin for trachoma, compared to untreated control communities. Methods and Findings: In a cluster-randomized trial for trachoma control in Ethiopia, 12 communities were randomized to receive mass azithromycin treatment of children aged 1-10 years at months 0, 3, 6, and 9. Twelve control communities were randomized to receive no antibiotic treatments until the conclusion of the study. Nasopharyngeal swabs were collected from randomly selected children in the treated group at baseline and month 12, and in the control group at month 12. Antibiotic susceptibility testing was performed on Streptococcus pneumoniae isolated from the swabs using Etest strips. In the treated group, the mean prevalence of azithromycin resistance among all monitored children increased from 3.6% (95% confidence interval [CI] 0.8%-8.9%) at baseline, to 46.9% (37.5%-57.5%) at month 12 (p =0.003). In control communities, azithromycin resistance was 9.2% (95% CI 6.7%-13.3%) at month 12, significantly lower than the treated group (p,0.0001). Penicillin resistance was identified in 0.8% (95% CI 0%-4.2%) of isolates in the control group at 1 year, and in no isolates in the children-treated group at baseline or 1 year. Conclusions: This cluster-randomized clinical trial demonstrated that compared to untreated control communities, nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities randomized to intensive azithromycin treatment. Mass azithromycin distributions were given more frequently than currently recommended by the World Health Organization's trachoma program. Azithromycin use in this setting did not select for resistance to penicillins, which remain the drug of choice for pneumococcal infections. © 2010 Skalet et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3001893/bin/pmed.1000377.s001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC3001893/bin/pmed.1000377.s002.doc
Authors & Co-Authors
Skalet, Alison H.
United States, San Francisco
University of California, San Francisco
Cevallos, Vicky E.
United States, San Francisco
University of California, San Francisco
Ayele, Berhan
United States, Atlanta
The Carter Center
Gebre, Teshome
United States, Atlanta
The Carter Center
Zhou, Zhaoxia
United States, San Francisco
University of California, San Francisco
Jorgensen, James H.
United States, San Antonio
University of Texas Health Science Center at San Antonio
Zerihun, Mulat
United States, Atlanta
The Carter Center
Habte, Dereje
United States, Atlanta
The Carter Center
Assefa, Yared
Ethiopia, Gondar
University of Gondar
Emerson, Paul
United States, Atlanta
The Carter Center
Gaynor, Bruce D.
United States, San Francisco
University of California, San Francisco
Porco, Travis C.
United States, San Francisco
University of California, San Francisco
Lietman, Thomas M.
United States, San Francisco
University of California, San Francisco
Keenan, Jeremy David
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 126
Authors: 14
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pmed.1000377
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Ethiopia