Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy

F. Ghaffar, I. R. Friedland, K. Katz, L. S. Muniz, J. L. Smith, P. Davis, J. Reynolds, Jr McCracken G.H.

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: We compared colonization and resistance rates of non- pneumococcal α-hemolytic streptococci (AHS) and Streptococcus pneumaniae in children receiving antibiotic therapy for acute otitis media. Study design: Between December 1997 and September 1998, children 6 months to 6 years of age, diagnosed with acute otitis media were randomly assigned to receive amoxicillin/clavulanate (Augmentin) 45 mg/kg/d in 2 divided doses for 10 days or azithromycin (Zithromax), 10 mg/kg, once on the first day, followed by 5 mg/kg daily for 4 days. Nasopharyngeal swabs for culture were obtained before and at 2 weeks and 2 months after the start of therapy. Streptococci were identified by species, and antibiotic susceptibility was determined by the epsilometric test. Results: One hundred six children completed the 2-week follow-up and 2-month follow-up, respectively. The nasopharyngeal carriage rate of nonpneumococcal AHS increased from 14% before treatment to 32% at the 2-week follow-up (P = .02) and was similar in both treatment groups. In contrast, the carriage of S pneumoniae decreased from 51% before therapy to 27% at the 2-week follow-up (P = .002). The carriage of penicillin-resistant AHS strains (minimum inhibitory concentration > 1 μg/mL) increased from 9% before treatment to 26% at 2 weeks and 36% at 2 months. Conclusions: Amoxicillin/clavulanate and azithromycin therapy resulted in increased isolation of nasopharyngeal non-pneumococcal AHS, many of which were multidrug-resistant, in contrast to a decrease in pneumococcal carriage. This suggests that the competitive balance between these 2 groups of organisms was disturbed as a result of differential antibiotic susceptibility. The importance of drug-resistant AHS as a reservoir for resistance genes for S pneumoniae warrants further investigation.

Original languageEnglish (US)
Pages (from-to)618-623
Number of pages6
JournalJournal of Pediatrics
Volume135
Issue number5
StatePublished - 1999

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Streptococcus
Anti-Bacterial Agents
Azithromycin
Clavulanic Acid
Amoxicillin
Otitis Media
Therapeutics
Pneumonia
Amoxicillin-Potassium Clavulanate Combination
Microbial Sensitivity Tests
Penicillins
Pharmaceutical Preparations
Genes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Ghaffar, F., Friedland, I. R., Katz, K., Muniz, L. S., Smith, J. L., Davis, P., ... McCracken G.H., J. (1999). Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy. Journal of Pediatrics, 135(5), 618-623.

Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy. / Ghaffar, F.; Friedland, I. R.; Katz, K.; Muniz, L. S.; Smith, J. L.; Davis, P.; Reynolds, J.; McCracken G.H., Jr.

In: Journal of Pediatrics, Vol. 135, No. 5, 1999, p. 618-623.

Research output: Contribution to journalArticle

Ghaffar, F, Friedland, IR, Katz, K, Muniz, LS, Smith, JL, Davis, P, Reynolds, J & McCracken G.H., J 1999, 'Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy', Journal of Pediatrics, vol. 135, no. 5, pp. 618-623.
Ghaffar F, Friedland IR, Katz K, Muniz LS, Smith JL, Davis P et al. Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy. Journal of Pediatrics. 1999;135(5):618-623.
Ghaffar, F. ; Friedland, I. R. ; Katz, K. ; Muniz, L. S. ; Smith, J. L. ; Davis, P. ; Reynolds, J. ; McCracken G.H., Jr. / Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy. In: Journal of Pediatrics. 1999 ; Vol. 135, No. 5. pp. 618-623.
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abstract = "Objective: We compared colonization and resistance rates of non- pneumococcal α-hemolytic streptococci (AHS) and Streptococcus pneumaniae in children receiving antibiotic therapy for acute otitis media. Study design: Between December 1997 and September 1998, children 6 months to 6 years of age, diagnosed with acute otitis media were randomly assigned to receive amoxicillin/clavulanate (Augmentin) 45 mg/kg/d in 2 divided doses for 10 days or azithromycin (Zithromax), 10 mg/kg, once on the first day, followed by 5 mg/kg daily for 4 days. Nasopharyngeal swabs for culture were obtained before and at 2 weeks and 2 months after the start of therapy. Streptococci were identified by species, and antibiotic susceptibility was determined by the epsilometric test. Results: One hundred six children completed the 2-week follow-up and 2-month follow-up, respectively. The nasopharyngeal carriage rate of nonpneumococcal AHS increased from 14{\%} before treatment to 32{\%} at the 2-week follow-up (P = .02) and was similar in both treatment groups. In contrast, the carriage of S pneumoniae decreased from 51{\%} before therapy to 27{\%} at the 2-week follow-up (P = .002). The carriage of penicillin-resistant AHS strains (minimum inhibitory concentration > 1 μg/mL) increased from 9{\%} before treatment to 26{\%} at 2 weeks and 36{\%} at 2 months. Conclusions: Amoxicillin/clavulanate and azithromycin therapy resulted in increased isolation of nasopharyngeal non-pneumococcal AHS, many of which were multidrug-resistant, in contrast to a decrease in pneumococcal carriage. This suggests that the competitive balance between these 2 groups of organisms was disturbed as a result of differential antibiotic susceptibility. The importance of drug-resistant AHS as a reservoir for resistance genes for S pneumoniae warrants further investigation.",
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AU - Ghaffar, F.

AU - Friedland, I. R.

AU - Katz, K.

AU - Muniz, L. S.

AU - Smith, J. L.

AU - Davis, P.

AU - Reynolds, J.

AU - McCracken G.H., Jr

PY - 1999

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N2 - Objective: We compared colonization and resistance rates of non- pneumococcal α-hemolytic streptococci (AHS) and Streptococcus pneumaniae in children receiving antibiotic therapy for acute otitis media. Study design: Between December 1997 and September 1998, children 6 months to 6 years of age, diagnosed with acute otitis media were randomly assigned to receive amoxicillin/clavulanate (Augmentin) 45 mg/kg/d in 2 divided doses for 10 days or azithromycin (Zithromax), 10 mg/kg, once on the first day, followed by 5 mg/kg daily for 4 days. Nasopharyngeal swabs for culture were obtained before and at 2 weeks and 2 months after the start of therapy. Streptococci were identified by species, and antibiotic susceptibility was determined by the epsilometric test. Results: One hundred six children completed the 2-week follow-up and 2-month follow-up, respectively. The nasopharyngeal carriage rate of nonpneumococcal AHS increased from 14% before treatment to 32% at the 2-week follow-up (P = .02) and was similar in both treatment groups. In contrast, the carriage of S pneumoniae decreased from 51% before therapy to 27% at the 2-week follow-up (P = .002). The carriage of penicillin-resistant AHS strains (minimum inhibitory concentration > 1 μg/mL) increased from 9% before treatment to 26% at 2 weeks and 36% at 2 months. Conclusions: Amoxicillin/clavulanate and azithromycin therapy resulted in increased isolation of nasopharyngeal non-pneumococcal AHS, many of which were multidrug-resistant, in contrast to a decrease in pneumococcal carriage. This suggests that the competitive balance between these 2 groups of organisms was disturbed as a result of differential antibiotic susceptibility. The importance of drug-resistant AHS as a reservoir for resistance genes for S pneumoniae warrants further investigation.

AB - Objective: We compared colonization and resistance rates of non- pneumococcal α-hemolytic streptococci (AHS) and Streptococcus pneumaniae in children receiving antibiotic therapy for acute otitis media. Study design: Between December 1997 and September 1998, children 6 months to 6 years of age, diagnosed with acute otitis media were randomly assigned to receive amoxicillin/clavulanate (Augmentin) 45 mg/kg/d in 2 divided doses for 10 days or azithromycin (Zithromax), 10 mg/kg, once on the first day, followed by 5 mg/kg daily for 4 days. Nasopharyngeal swabs for culture were obtained before and at 2 weeks and 2 months after the start of therapy. Streptococci were identified by species, and antibiotic susceptibility was determined by the epsilometric test. Results: One hundred six children completed the 2-week follow-up and 2-month follow-up, respectively. The nasopharyngeal carriage rate of nonpneumococcal AHS increased from 14% before treatment to 32% at the 2-week follow-up (P = .02) and was similar in both treatment groups. In contrast, the carriage of S pneumoniae decreased from 51% before therapy to 27% at the 2-week follow-up (P = .002). The carriage of penicillin-resistant AHS strains (minimum inhibitory concentration > 1 μg/mL) increased from 9% before treatment to 26% at 2 weeks and 36% at 2 months. Conclusions: Amoxicillin/clavulanate and azithromycin therapy resulted in increased isolation of nasopharyngeal non-pneumococcal AHS, many of which were multidrug-resistant, in contrast to a decrease in pneumococcal carriage. This suggests that the competitive balance between these 2 groups of organisms was disturbed as a result of differential antibiotic susceptibility. The importance of drug-resistant AHS as a reservoir for resistance genes for S pneumoniae warrants further investigation.

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