Mass administration of azithromycin and<i>Streptococcus pneumoniae</i>carriage: cross-sectional surveys in the Gambia

Burr, Sarah E.; Milne, Sally; Jafali, James; Bojang, Ebrima; Rajasekhar, Megha; Hart, John; Harding-Esch, Emma; Holland, Martin J.; Mabey, David; Sillah, Ansumana; Bailey, Robin L.; Roca, Anna

doi:10.2471/blt.13.133462

Cited by 28 publications

(50 citation statements)

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“…Mass administration (MDA) of AZ to children has been associated with increased nasopharyngeal carriage of macrolide-resistant pneumococci, particularly when MDA was given at 6-to 12-monthly intervals (15)(16)(17)(18)(19)(20). However, this is not a unanimous finding (21) and may in part depend on the prevalence of resistant isolates at baseline (15)(16)(17)(18). Longitudinal studies of carriage and resistance patterns indicate that in the event of MDA-driven temporary expansion of macrolide-resistant isolates, a decrease in their prevalence tends to occur 12 to 24 months after the most recent treatment (19,20).…”

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confidence: 38%

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Impact of Intermittent Preventive Treatment in Pregnancy with Azithromycin-Containing Regimens on Maternal Nasopharyngeal Carriage and Antibiotic Sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a Cross-Sectional Survey at Delivery

et al. 2015

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Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) can prevent low birth weight (LBW; Ͻ2,500 g) and reduces infant morbidity and mortality in resource-limited countries (1, 2). However, high-level resistance of Plasmodium falciparum to SP, recently observed in East Africa, may render IPTp-SP clinically inefficacious (3-5). The development and evaluation of new IPTp regimens are therefore of utmost importance (6, 7).Azithromycin (AZ) is a broad-spectrum macrolide (azalide) antibiotic with favorable antimalarial properties and a good safety profile in pregnancy (8, 9). IPTp with SPAZ prevented LBW and preterm delivery in two clinical trials (10, 11), and confounding may in part explain the observation of no effect in the third (6, 12); this warrants its further evaluation as a potential alternative to SP-IPTp.An integral part of such evaluation is to screen for adverse consequences, including the selection of drug-resistant Streptococcus pneumoniae (13), a principal cause of meningitis and respiratory infections in infants (14). Mass administration (MDA) of AZ to children has been associated with increased nasopharyngeal carriage of macrolide-resistant pneumococci, particularly when MDA was given at 6-to 12-monthly intervals (15)(16)(17)(18)(19)(20). However, this is not a unanimous finding (21) and may in part depend on the prevalence of resistant isolates at baseline (15-18). Longitudinal studies of carriage and resistance patterns indicate that in the event of MDA-driven temporary expansion of macrolide-resistant isolates, a decrease in their prevalence tends to occur 12 to 24 months after the most recent treatment (19,20). Citation Unger HW, Aho C, Ome-Kaius M, Wangnapi RA, Umbers AJ, Jack W, Lafana A, Michael A, Hanieh S, Siba P, Mueller I, Greenhill AR, Rogerson SJ. 2015. Impact of intermittent preventive treatment in pregnancy with azithromycincontaining regimens on maternal nasopharyngeal carriage and antibiotic sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a cross-sectional survey at delivery.

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confidence: 38%

“…With an intermission of ϳ2 years, macrolide-resistant isolates may have been eliminated as a result of the cost associated with drug resistance (39). By comparison, MDA repeated in short intervals may increase the risk of antimicrobial resistance (20), although evidence remains inconclusive (21).…”

Section: Discussionmentioning

confidence: 99%

Impact of Intermittent Preventive Treatment in Pregnancy with Azithromycin-Containing Regimens on Maternal Nasopharyngeal Carriage and Antibiotic Sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a Cross-Sectional Survey at Delivery

et al. 2015

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“…Treatment was a single oral dose of 20 mg azithromycin per kg to a maximum of 1 g and height was used as a proxy for weight. A pneumococcal carriage study was nested within PRET [12] and was carried out in eight villages that were a part of the larger trial. This included two villages that had been randomized, by the underlying PRET trial, to three annual rounds of MDA (3 × treatment arm) and six villages that received a single treatment round (1 × treatment arm) (Figs.…”

Section: Methodsmentioning

confidence: 99%

“…At each CSS, a nasopharyngeal swab (NPS) was collected from each participant and a questionnaire, pertaining to demographic characteristics, socioeconomic status and recent antibiotic use (within the last 30 days), was conducted. In the present study, we analysed all NPS samples collected as a part of the pneumococcal carriage study [12] to determine the prevalence of S. aureus carriage, including carriage of macrolide resistant strains.…”

Section: Methodsmentioning

confidence: 99%

“…However, there are data supporting an association of MDA with the emergence of macrolide-resistant Streptococcus pneumoniae isolated from the nasopahrnyx, at least in some settings. While studies carried out in Tanzania, Nepal and The Gambia have shown no evidence of such resistance following a single treatment round [10–12], other studies in Tanzania, Nepal and Australia suggest resistance does emerge after just one or two annual rounds of mass treatment [13–15]. Further studies in Ethiopia have documented increased macrolide resistant pneumococci isolated following four rounds of MDA given at 3 month intervals [16] and following six biannual rounds over a period of 3 years [17].…”

Section: Introductionmentioning

confidence: 99%

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Short-term increase in prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus following mass drug administration with azithromycin for trachoma control

et al. 2017

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BackgroundMass drug administration (MDA) with azithromycin is a corner-stone of trachoma control however it may drive the emergence of antimicrobial resistance. In a cluster-randomized trial (Clinical trial gov NCT00792922), we compared the reduction in the prevalence of active trachoma in communities that received three annual rounds of MDA to that in communities that received a single treatment round. We used the framework of this trial to carry out an opportunistic study to investigate if the increased rounds of treatment resulted in increased prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus. Three cross-sectional surveys were conducted in two villages receiving three annual rounds of MDA (3 × treatment arm). Surveys were conducted immediately before the third round of MDA (CSS-1) and at one (CSS-2) and six (CSS-3) months after MDA. The final survey also included six villages that had received only one round of MDA 30 months previously (1 × treatment arm).ResultsIn the 3 × treatment arm, a short-term increase in prevalence of S. aureus carriage was seen following MDA from 24.6% at CSS-1 to 38.6% at CSS-2 (p < 0.001). Prevalence fell to 8.8% at CSS-3 (p < 0.001). A transient increase was also seen in prevalence of carriage of azithromycin resistant (AzmR) strains from 8.9% at CSS-1 to 34.1% (p < 0.001) in CSS-2 and down to 7.3% (p = 0.417) in CSS-3. A similar trend was observed for prevalence of carriage of macrolide-inducible-clindamycin resistant (iMLSB) strains. In CSS-3, prevalence of carriage of resistant strains was higher in the 3 × treatment arm than in the 1 × treatment (AzmR 7.3% vs. 1.6%, p = 0.010; iMLSB 5.8% vs. 0.8%, p < 0.001). Macrolide resistance was attributed to the presence of msr and erm genes.ConclusionsThree annual rounds of MDA with azithromycin were associated with a short-term increase in both the prevalence of nasopharyngeal carriage of S. aureus and prevalence of carriage of AzmR and iMLSB S. aureus.Trial registrationThis study was ancillary to the Partnership for the Rapid Elimination of Trachoma, ClinicalTrials.gov NCT00792922, registration date November 17, 2008.

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Antibiotics for trachoma

Evans

Solomon

Kumar

et al. 2019

Cochrane Database of Systematic Reviews

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

Cited by 28 publications

References 24 publications

Impact of Intermittent Preventive Treatment in Pregnancy with Azithromycin-Containing Regimens on Maternal Nasopharyngeal Carriage and Antibiotic Sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a Cross-Sectional Survey at Delivery

Impact of Intermittent Preventive Treatment in Pregnancy with Azithromycin-Containing Regimens on Maternal Nasopharyngeal Carriage and Antibiotic Sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a Cross-Sectional Survey at Delivery

Short-term increase in prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus following mass drug administration with azithromycin for trachoma control

Antibiotics for trachoma

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