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Effect of βlactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7328.28 (Published 05 January 2002) Cite this as: BMJ 2002;324:28
  1. Dilruba Nasrin, postgraduate student (nasrindilruba{at}hotmail.com)a,
  2. Peter J Collignon, directorb,
  3. Leslee Roberts, fellowa,
  4. Eileen J Wilson, postgraduate studenta,
  5. Louis S Pilotto, professor and head of departmentc,
  6. Robert M Douglas, directora
  1. a National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 0200, Australia
  2. b Infectious Diseases Unit and Microbiology Department, Canberra Hospital, Canberra
  3. c Department of General Practice, Flinders University of South Australia, Adelaide, SA, Australia
  1. Correspondence to: Dr Dilruba Nasrin, 9C-A Impiana Condo, 1 Tasik Ampang, Jln Ulu Klang, Ampang 68000, Selangor, Malaysia
  • Accepted 1 October 2001

Abstract

Objective: To examine the relation between use of antibiotics in a cohort of preschool children and nasal carriage of resistant strains of pneumococcus.

Design and participants: Prospective cohort study over two years of 461 children aged under 4 years living in Canberra, Australia.

Main outcome measures: Use of drugs, respiratory symptoms, and visits to doctors were documented in a daily diary by parents of the children during 25 months of observation. Isolates of pneumococci, which were cultured from nasal swabs collected approximately six monthly, were tested for antibiotic resistance.

Results: From the four swab collections 631 positive pneumococcal isolates from 461 children were found, of which 13.6% were resistant to penicillin. Presence of penicillin resistant pneumococci was significantly associated with children's use of a β lactam antibiotic in the two months before each swab collection (odds ratio 2.03 (95% confidence interval 1.15 to 3.56, P=0.01)). The odds ratio of the association remained >1 (though did not reach significance at the 0.05 level) for use in the six months before swab collection. The association was seen in children who received only penicillin or only cephalosporin antibiotics in that period. The odds ratio was 4.67 (1.29 to 17.09, P=0.02) in children who had received both types of β lactam in the two months before their nasal swab. The modelled odds of carrying penicillin resistant pneumococcus was 4% higher for each additional day of use of β lactam antibiotics in the six months before swab collection.

Conclusions: Reduction in β lactam use could quickly reduce the carriage rates of penicillin resistant pneumococci in early childhood. In view of the propensity of these organisms to be spread among children in the community, the prevalence of penicillin resistant organisms may fall as a consequence.

What is already known on this topic

What is already known on this topic Resistance to pneumococcal antibiotics is increasing worldwide

One possible cause of resistance is the excessive use of antibiotics in children with respiratory symptoms

Few cross sectional studies have looked at the association between antibiotic use and subsequent carriage of organisms resistant to penicillin

What this study adds

What this study adds Carriage of pneumococcus is high in preschool Australian children throughout the year and highest in winter

The likelihood of carrying penicillin resistant pneumococcus is doubled in children who have used any β lactam antibiotic in the two months before testing

The likelihood of a child carrying a penicillin resistant pneumococcus is increased by 4% for each additional day of β lactam use in the six months before testing

Footnotes

  • Funding The study was funded by research grants to RMD from the general practice evaluation programme of the Australian Department of Health and Aged Care and from SmithKline Beecham Pharmaceuticals to RMD.

  • Competing interests None declared.

  • Accepted 1 October 2001
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