TY - JOUR
T1 - Increased carriage of resistant non-pneumococcal α-hemolytic streptococci after antibiotic therapy
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
N1 - Funding Information:
Supported in part by a grant from SmithKline Beecham Pharmaceuticals.
PY - 1999
Y1 - 1999
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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U2 - 10.1016/S0022-3476(99)70061-2
DO - 10.1016/S0022-3476(99)70061-2
M3 - Article
C2 - 10547251
AN - SCOPUS:0033511285
SN - 0022-3476
VL - 135
SP - 618
EP - 623
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 5
ER -