THE IMPACT OF MASS AZITHROMYCIN TREATMENTS ON ANTIBIOTIC RESISTANCE AND THE DISTRIBUTION OF S. PNEUMONIAE SEROTYPES IN ETHIOPIA Público
Sahlu, Ida (2011)
Published
Abstract
Background: Trachoma is one of the leading preventable causes of
blindness in the
developing world. The World Health Organization recommends repeated
annual mass
oral azithromycin treatments for entire districts where the
prevalence exceeds 10%
among children aged 1-9 years old. S. pneumoniae, with more
than 93 serotypes, is one
of the leading causes of child mortality in the developing world.
Repeated annual mass
antibiotic treatment has raised concerns in both the development of
antibiotic resistant
strains of S. pneumoniae and the change in serotype
distribution. This research was
conducted to determine whether treatment with oral azithromycin and
increased resistant
strains changed the distribution of seven-valent vaccine
serotypes.
Methods: The study was a population-based, cluster-randomized
clinical trial of quarterly
mass oral azithromycin treatments (20 mg/kg) for trachoma.
Nasopharyngeal swabs were
collected from 10 children of each sentinel community. S.
pneumoniae strains were
isolated and serotypes were identified. Resistance to the following
antibiotics:
azithromycin, penicillin, clindamycin and tetracycline, was
evaluated by MICs and
included in the analysis. Chi-square tests were performed to
compare serotype
distribution. Logistic regression was used to determine whether
treatment and population
characteristics were associated with seven-valent vaccine
serotypes.
Results: The difference in proportions for the most prevalent
serotypes in the study (19F,
6B, 6A, 7F and 9L) at baseline and at one-year follow-up was not
statistically significant
(p-value=0.58). The association between treatment and vaccine
serotypes was not
statistically significant for the univariate and multivariate
analyses (OR=1.02, 95%
CI=0.49-2.15, OR=1.14, 95% CI=0.42-3.08, respectively).
Azithromycin resistance
increased from 5.8% at baseline to 60.7% at one-year follow up (p=
<0.0001). The
multivariate analysis included gender, trachoma, age,
azithromycin-, penicillin-,
clindamycin- and tetracycline-resistance. Azithromycin resistance
was associated with
non-vaccine serotypes (OR=29.59, 95% CI=3.01-291.17), while
penicillin-, clindamycin-
and tetracycline-resistance were associated with vaccine serotypes
after adjusting for
other covariates (OR=4.98, 95% CI=0.996-24.87; OR=57.91, 95%
CI=5.13-653.83;
OR=5.07, 95% CI=1.51-16.98, respectively).
Conclusion: Mass treatments with oral azithromycin did not change
the overall
distribution of serotypes but did increase antibiotic resistance.
Azithromycin resistance
selects for non-vaccine serotypes, while resistance to penicillin,
clindamycin and
tetracycline were associated with vaccine serotypes.
Table of Contents
TABLE OF CONTENTS
BACKGROUND .................................................................................................................................................... 1
METHODS .........................................................................................................................................................12
RESULTS ..........................................................................................................................................................22
DISCUSSION .....................................................................................................................................................28
REFERENCES .....................................................................................................................................................35
FIGURES ...........................................................................................................................................................42
TABLES ........................................................................................................................................................... 46
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