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Topical ocular antibiotics induce bacterial resistance at extraocular sites
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  1. B D Gaynor1,2,
  2. J D Chidambaram1,
  3. V Cevallos1,
  4. Y Miao1,
  5. K Miller1,
  6. H C Jha4,
  7. R C Bhatta4,
  8. J S P Chaudhary4,
  9. S Osaki Holm1,
  10. J P Whitcher1,3,
  11. K A Holbrook5,
  12. A M Fry6,
  13. T M Lietman1,3
  1. 1The F I Proctor Foundation, University of California, San Francisco, CA, USA
  2. 2Department of Ophthalmology, University of California, San Francisco, CA, USA
  3. 3Institute for Global Health, University of California, San Francisco, CA, USA
  4. 4Geta Eye Hospital, Geta, Nepal
  5. 5Department of Public Health, San Francisco, CA, USA
  6. 6Respiratory Diseases Branch, Centers for Disease Control, Atlanta, GA, USA
  1. Correspondence to: Associate Professor T M Lietman Director of the WHO Collaborating Center for the Prevention of Blindness, Department of Ophthalmology, F I Proctor Foundation, 95 Kirkham Street, Room 307, University of California San Francisco, San Francisco, CA 94143-0944, USA; TMLitsa.ucsf.edu

Abstract

Aim: To compare the prevalence of antibiotic resistance found in nasopharyngeal Streptococcus pneumoniae between villages treated with topical tetracycline or systemic azithromycin as part of a trachoma control programme.

Methods: All children aged 1–10 years were offered either single dose oral azithromycin treatment (20 mg/kg) or a course of topical 1% tetracycline ointment, depending on the area. Treatment was given annually for 3 years. Six months after the third annual treatment in each village, children were surveyed for nasopharyngeal carriage of S pneumoniae and resistance was determined using broth dilution MIC technique. Children in two additional villages, which had not yet been treated, were also surveyed.

Results: Nasopharyngeal carriage of S pneumoniae was similar in the tetracycline treated, azithromycin treated, and untreated areas (p = 0.57). However, resistance to tetracycline and azithromycin was distributed differently between the three areas (p = 0.004). The village treated with topical tetracycline had a higher prevalence of tetracycline resistance than the other villages (p = 0.010), while the oral azithromycin treated village had a higher prevalence of macrolide resistance than the other villages (p = 0.014).

Conclusions: Annual mass treatment with oral azithromycin may alter the prevalence of drug resistant S pneumoniae in a community. Surprisingly, topical tetracycline may also increase nasopharyngeal pneumococcal resistance. Topical antibiotics may have an effect on extraocular bacterial resistance.

  • NCCLS, National Committee for Clinical Laboratory Standards
  • azithromycin
  • pneumococcus
  • resistance
  • trachoma
  • tetracycline
  • NCCLS, National Committee for Clinical Laboratory Standards
  • azithromycin
  • pneumococcus
  • resistance
  • trachoma
  • tetracycline

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Footnotes

  • This project was carried out through the generous support of the National Institute of Allergy and Infectious Diseases (Grant R21 AI55752-01), Research to Prevent Blindness (NYC), the Edna McConnell Clark Foundation (NYC), Pfizer Inc, (who donated the azithromycin; NYC), That Man May See, and the South Asia Research Fund, UCSF.

  • Competing interests: none declared

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