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Antimicrobial Agents and Chemotherapy, September 2003, p. 2765-2769, Vol. 47, No. 9
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.9.2765-2769.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Impact of Azithromycin Administration for Trachoma Control on the Carriage of Antibiotic-Resistant Streptococcus pneumoniae

Department of Medical Microbiology, University College London, Royal Free Campus, London NW3 2PF,¹ London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom,² Huruma Hospital, Huruma,³ Clinical Laboratory, Kilimanjaro Christian Medical College, Moshi, Tanzania,⁴ Pfizer Inc., New York, New York 10017-5755⁵

Received 13 February 2003/ Returned for modification 4 March 2003/ Accepted 9 June 2003

Community distribution of azithromycin has an important role to play in trachoma control. Previous studies have suggested that this may increase the prevalence of macrolide-resistant Streptococcus pneumoniae. S. pneumoniae was isolated from children under 7 years of age in Rombo District, northern Tanzania, before and 2 and 6 months after community-wide administration of azithromycin. Overall carriage rates were 11, 12, and 7%, respectively. Only one macrolide-resistant isolate carrying the mef gene was obtained 6 months after azithromycin administration. This contrasted with cotrimoxazole and penicillin resistance, both of which were common (cotrimoxazole resistance, 42, 43, and 47%, and penicillin resistance, 21, 17, and 16% at baseline, 2 months, and 6 months, respectively). There was a significant association between cotrimoxazole and penicillin resistance (P < 0.0001, Fisher's exact). These data suggest that in communities where macrolide resistance is rare, azithromycin distribution for trachoma control is unlikely to increase the prevalence of resistant organisms.

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