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

Clin Infect Dis. 1997 Mar;24(3):356-62. doi: 10.1093/clinids/24.3.356.

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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / pharmacology
  • Azithromycin / therapeutic use*
  • Carrier State / microbiology*
  • Child
  • Child, Preschool
  • Drug Resistance, Microbial
  • Erythromycin / pharmacology
  • Humans
  • Longitudinal Studies
  • Nasopharynx / microbiology
  • Northern Territory
  • Oceanic Ancestry Group
  • Pneumococcal Infections / microbiology*
  • Prospective Studies
  • Streptococcus pneumoniae / drug effects
  • Streptococcus pneumoniae / isolation & purification*
  • Trachoma / drug therapy*

Substances

  • Anti-Bacterial Agents
  • Erythromycin
  • Azithromycin