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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of cotrimoxazole on carriage and antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae in HIV-infected children in Zambia
Antimicrobial Agents and Chemotherapy, Volume 54, No. 9, Year 2010
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Description
This is a substudy of a larger randomized controlled trial on HIV-infected Zambian children, which revealed that cotrimoxazole prophylaxis reduced morbidity and mortality despite a background of high cotrimoxazole resistance. The impact of cotrimoxazole on the carriage and antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae as major causes of childhood mortality in HIV-infected children was investigated since these are unclear. Representative nasopharyngeal swabs were taken prior to randomization for 181 of 534 children (92 on cotrimoxazole and 89 on placebo). Bacterial identification and antibiotic susceptibility were performed by routine methods. Due to reduced mortality, prophylactic cotrimoxazole increased the median time from randomization to the last specimen from 48 to 56 months (P = 0.001). The carriage of H. influenzae was unaltered by cotrimoxazole. Carriage of S. pneumoniae increased slightly in both arms but was not statistically significant in the placebo arm. In S. pneumoniae switching between carriage and no carriage in consecutive pairs of samples was unaffected by cotrimoxazole (P = 0.18) with a suggestion that the probability of remaining carriage free was lower (P = 0.10). In H. influenzae cotrimoxazole decreased switching from carriage to no carriage (P = 0.02). Cotrimoxazole resistance levels were higher in postbaseline samples in the cotrimoxazole arm than in the placebo arm (S. pneumoniae, P < 0.0001; H. influenzae, P = 0.005). Cotrimoxazole decreased switching from cotrimoxazole resistance to cotrimoxazole sensitivity in S. pneumoniae (P = 0.002) and reduced the chance of H. influenzae remaining cotrimoxazole sensitive (P = 0.05). No associations were observed between the percentage of CD4 (CD4%), the change in CD4% from baseline, child age at date of specimen, child gender, or sampling month with carriage of either pathogen. Copyright © 2010, American Society for Microbiology. All Rights Reserved.
Authors & Co-Authors
Mwenya, Darlington M.
Zambia, Lusaka
University Teaching Hospital Lusaka
United Kingdom, London
Ucl Medical School
Charalambous, B. M.
United Kingdom, London
Ucl Medical School
Phillips, Patrick P.J.
United Kingdom, London
Medical Research Council
Mwansa, James Chisenga Lucian
Zambia, Lusaka
University Teaching Hospital Lusaka
Batt, S. L.
United Kingdom, London
Ucl Medical School
Nunn, Andrew J.
United Kingdom, London
Medical Research Council
Walker, Sarah A.S.
United Kingdom, London
Medical Research Council
Gibb, Diana M.
United Kingdom, London
Medical Research Council
Gillespie, Stephen H.
United Kingdom, London
Ucl Medical School
Statistics
Citations: 40
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.1128/AAC.01409-09
ISSN:
00664804
e-ISSN:
10986596
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Study Approach
Quantitative
Study Locations
Zambia