Mass Distribution of Azithromycin for Trachoma Control Is Associated With Increased Risk of Azithromycin-Resistant Streptococcus pneumoniae Carriage in Young Children 6 Months After Treatment

Coles, Christian; Kasubi, Mabula; Seidman, Jessica C.; Levens, Joshua; Mkocha, Harran; Muñoz, Beatriz; Mfinanga, Sayoki; West, Sheila K.

doi:10.1093/cid/cit137

Cited by 71 publications

(88 citation statements)

References 26 publications

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“…Clinical studies in CF patients colonized by P. aeruginosa demonstrated an improvement in respiratory function and a reduced number of exacerbations compared with the placebo (301). Nevertheless, recent data suggest that the chronic use of azithromycin might be associated with side effects, such as ototoxicity and an increased level of bacterial resistance (302,303). Possible cardiovascular toxicity has been described, with conflicting results (304).…”

Section: Targeting Biofilm Recalcitrance: Progress and Perspectivesmentioning

confidence: 99%

Biofilm-Related Infections: Bridging the Gap between Clinical Management and Fundamental Aspects of Recalcitrance toward Antibiotics

Lebeaux

Ghigo

Beloin

2014

Microbiol Mol Biol Rev

937

785

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International audienceSurface-associated microbial communities, called biofilms, are present in all environments. Although biofilms play an important positive role in a variety of ecosystems, they also have many negative effects, including biofilm-related infections in medical settings. The ability of pathogenic biofilms to survive in the presence of high concentrations of antibiotics is called "recalcitrance" and is a characteristic property of the biofilm lifestyle, leading to treatment failure and infection recurrence. This review presents our current understanding of the molecular mechanisms of biofilm recalcitrance toward antibiotics and describes how recent progress has improved our capacity to design original and efficient strategies to prevent or eradicate biofilm-related infections

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Section: Targeting Biofilm Recalcitrance: Progress and Perspectivesmentioning

confidence: 99%

Biofilm-Related Infections: Bridging the Gap between Clinical Management and Fundamental Aspects of Recalcitrance toward Antibiotics

Lebeaux

Ghigo

Beloin

2014

Microbiol Mol Biol Rev

937

785

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“…The marked reduction in pneumococcal carriage in the SPAZ group has not been observed in all MDA studies (20). SPAZ-IPTp is administered to a comparatively small fraction of the community, as opposed to MDA, which involves the simultaneous treatment with lower dose of AZ (20 mg/kg of body weight; maximum, 1,000 mg) of many individuals at a single time point.…”

Section: Discussionmentioning

confidence: 95%

“…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).…”

mentioning

confidence: 99%

“…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).…”

mentioning

confidence: 99%

“…In addition to macrolide resistance, MDA has also been associated with selection of ␤-lactam-resistant pneumococci (22) and causes serotype replacement, which is probably temporary (15); the consequences for clinical response in severe pediatric infections remain to be elucidated (20). Furthermore, it is unclear whether MDA preferentially selects for nonvaccine serotypes, whose role in severe infection requires further investigation (15).…”

mentioning

confidence: 99%

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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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Streptococcus pneumoniae and chronic endobronchial infections in childhood

Hare

Leach

Smith‐Vaughan

et al. 2017

Pediatric Pulmonology

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Streptococcus pneumoniae (pneumococcus) is the main cause of bacterial pneumonia worldwide and has been studied extensively in this context. However, its role in chronic endobronchial infections and accompanying lower airway neutrophilic infiltration has received little attention. Severe and recurrent pneumonia are risk factors for chronic suppurative lung disease (CSLD) and bronchiectasis; the latter causes considerable morbidity and, in some populations, premature death in children and adults. Protracted bacterial bronchitis (PBB) is another chronic endobronchial infection associated with substantial morbidity. In some children, PBB may progress to bronchiectasis. Although nontypeable Haemophilus influenzae is the main pathogen in PBB, CSLD and bronchiectasis, pneumococci are isolated commonly from the lower airways of children with these diagnoses. Here we review what is known currently about pneumococci in PBB, CSLD and bronchiectasis, including the importance of pneumococcal nasopharyngeal colonization and how persistence in the lower airways may contribute to the pathogenesis of these chronic pulmonary disorders. Antibiotic treatments, particularly long-term azithromycin therapy, are discussed together with antibiotic resistance and the impact of pneumococcal conjugate vaccines. Important areas requiring further investigation are identified, including immune responses associated with pneumococcal lower airway infection, alone and in combination with other respiratory pathogens, and microarray serotyping to improve detection of carriage and infection by multiple serotypes. Genome wide association studies of pneumococci from the upper and lower airways will help identify virulence and resistance determinants, including potential therapeutic targets and vaccine antigens to treat and prevent endobronchial infections. Much work is needed, but the benefits will be substantial.

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Mass Distribution of Azithromycin for Trachoma Control Is Associated With Increased Risk of Azithromycin-Resistant Streptococcus pneumoniae Carriage in Young Children 6 Months After Treatment

Cited by 71 publications

References 26 publications

Biofilm-Related Infections: Bridging the Gap between Clinical Management and Fundamental Aspects of Recalcitrance toward Antibiotics

Biofilm-Related Infections: Bridging the Gap between Clinical Management and Fundamental Aspects of Recalcitrance toward Antibiotics

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

Streptococcus pneumoniae and chronic endobronchial infections in childhood

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