The Decline of Pneumococcal Resistance after Cessation of Mass Antibiotic Distributions for Trachoma

Abstract

After 6 biannual mass distributions of oral azithromycin for trachoma in Ethiopian communities, 76.8% (95% confidence interval [CI], 66.3%-85.1%) of nasopharyngeal Streptococcus pneumoniae isolates from children aged 1-5 years were resistant to macrolides. Twelve and 24 months after the last azithromycin treatment, resistance decreased to 30.6% (95% CI, 18.8%-40.4%; P <.001 ) and 20.8% (95% CI, 12.7%-30.7%; P < .001), respectively. Macrolide resistance decreases after antibiotic pressure is removed.

Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

“…However, exposure to azithromycin and other broad-spectrum antibiotics has increased globally over the past decade, and many trachoma-endemic areas have received several rounds of treatment, which increases distribution of drug-resistant isolates and their duration in communities. 28 Given this concern, we are analyzing nasopharyngeal S. pneumoniae specimens and diarrheal and non-diarrheal fecal samples from children in the study to assess the impact of azithromycin on the patterns of drug resistance among pathogenic and non-pathogenic bacteria.…”

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

“…Although currently there is no evidence that repeated MDA increases the prevalence of azithromycinresistant C. trachomatis, 9 there is epidemiological evidence suggesting that pharyngeal carriage of macrolide-resistant Streptococcus pneumoniae increases following repeated MDA for trachoma control. 10,11 Because S. pneumoniae is a leading cause of childhood mortality, especially in Africa, and because asymptomatic nasopharyngeal carriage is the initial step in the pathogenesis of pneumococcal disease, increased carriage of macrolide-resistant strains is a public health concern.…”

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

“…Pneumococcal carriage and susceptibility patterns at delivery in the SPCQ group may mirror the general, pretreatment population of pregnant women; however, receipt of a single course of SPCQ could affect bacterial colonization and antibiotic sensitivities (40). Single-point sampling precluded the evaluation of both recolonization rates following treatment or after delivery and long-term effects of SPAZ on persistence of macrolide-resistant pneumococci and serotype replacement that were observed in MDA studies (15,19,20). Paired mother-infant nasopharyngeal specimens could have demonstrated the rates of mother-to-infant transfer of specific isolates from mother to infant; data from The Gambia suggest that the population-attributable fraction of infant carriage due to maternal carriage is low (9.5%) (36).…”

“…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).…”

“…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).…”