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Community prescribing and resistant Streptococcus pneumoniae.

Barkai G, Greenberg D, Givon-Lavi N, Dreifuss E, Vardy D, Dagan R - Emerging Infect. Dis. (2005)

Bottom Line: In both populations, antimicrobial prescriptions were markedly reduced over time, especially for penicillins and erythromycin.In contrast, azithromycin prescriptions increased from 1998 to 2001 with a parallel increase in macrolide and multidrug resistance.Penicillin resistance was associated with macrolide resistance.

View Article: PubMed Central - PubMed

Affiliation: Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel.

ABSTRACT
We investigated the association between prescribing antimicrobial agents and antimicrobial resistance of Streptococcus pneumoniae among children with acute otitis media in southern Israel. During a 6-year period, all prescriptions of a sample of approximately 20% of Jewish and Bedouin children <5 years of age were recorded and all pneumococcal isolates from middle ear fluid were collected. Although antimicrobial drug use was significantly higher in Bedouin children, the proportion of S. pneumoniae isolates with penicillin MIC = or > 1.0 microg/mL was significantly higher in Jewish children. In both populations, antimicrobial prescriptions were markedly reduced over time, especially for penicillins and erythromycin. In contrast, azithromycin prescriptions increased from 1998 to 2001 with a parallel increase in macrolide and multidrug resistance. Penicillin resistance was associated with macrolide resistance. These findings strongly suggest that azithromycin affects increased antimicrobial resistance, including multidrug resistance, in S. pneumoniae.

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Proportions of erythromycin-resistant and multidrug-resistant Streptococcus pneumoniae isolated during episodes of acute otitis media in Bedouin and Jewish children <5 years of age in southern Israel from 1999 through 2003. Ery-R, erythromycin resistance; MDR, multidrug resistance (resistance to ≥3 antimicrobial classes).
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Figure 3: Proportions of erythromycin-resistant and multidrug-resistant Streptococcus pneumoniae isolated during episodes of acute otitis media in Bedouin and Jewish children <5 years of age in southern Israel from 1999 through 2003. Ery-R, erythromycin resistance; MDR, multidrug resistance (resistance to ≥3 antimicrobial classes).

Mentions: Erythromycin resistance was more common in Jewish (25%, 356/1,425) than in Bedouin children (16%, 355/2,221) (p<0.001). In Bedouin children, rates of erythromycin resistance increased significantly from 1999 through 2002, from 9% (41/456) to 21% (93/440), respectively (p<0.001). In Jewish children, erythromycin resistance decreased from 23% (61/261) in 1999 to 18% (48/270) in 2000 (p = 0.01). Thereafter, the proportion of resistant isolates increased as well, reaching 29% (84/291) in 2002 (p = 0.02). Erythromycin resistance did not increase in either population during 2003. In 2003, 17% (63/375) and 27% (90/336) of isolates in Bedouin and Jewish children, respectively, were erythromycin-resistant (Figure 3). The multidrug-resistance pattern paralleled that of erythromycin resistance in each population. Thus, both erythromycin and multidrug resistance increased in parallel with the increase in the azithromycin prescription rate, and resistance tended to decrease with the change in this rate. Furthermore, the population with the highest azithromycin prescription rate also had the highest rates of erythromycin resistance.


Community prescribing and resistant Streptococcus pneumoniae.

Barkai G, Greenberg D, Givon-Lavi N, Dreifuss E, Vardy D, Dagan R - Emerging Infect. Dis. (2005)

Proportions of erythromycin-resistant and multidrug-resistant Streptococcus pneumoniae isolated during episodes of acute otitis media in Bedouin and Jewish children <5 years of age in southern Israel from 1999 through 2003. Ery-R, erythromycin resistance; MDR, multidrug resistance (resistance to ≥3 antimicrobial classes).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3367585&req=5

Figure 3: Proportions of erythromycin-resistant and multidrug-resistant Streptococcus pneumoniae isolated during episodes of acute otitis media in Bedouin and Jewish children <5 years of age in southern Israel from 1999 through 2003. Ery-R, erythromycin resistance; MDR, multidrug resistance (resistance to ≥3 antimicrobial classes).
Mentions: Erythromycin resistance was more common in Jewish (25%, 356/1,425) than in Bedouin children (16%, 355/2,221) (p<0.001). In Bedouin children, rates of erythromycin resistance increased significantly from 1999 through 2002, from 9% (41/456) to 21% (93/440), respectively (p<0.001). In Jewish children, erythromycin resistance decreased from 23% (61/261) in 1999 to 18% (48/270) in 2000 (p = 0.01). Thereafter, the proportion of resistant isolates increased as well, reaching 29% (84/291) in 2002 (p = 0.02). Erythromycin resistance did not increase in either population during 2003. In 2003, 17% (63/375) and 27% (90/336) of isolates in Bedouin and Jewish children, respectively, were erythromycin-resistant (Figure 3). The multidrug-resistance pattern paralleled that of erythromycin resistance in each population. Thus, both erythromycin and multidrug resistance increased in parallel with the increase in the azithromycin prescription rate, and resistance tended to decrease with the change in this rate. Furthermore, the population with the highest azithromycin prescription rate also had the highest rates of erythromycin resistance.

Bottom Line: In both populations, antimicrobial prescriptions were markedly reduced over time, especially for penicillins and erythromycin.In contrast, azithromycin prescriptions increased from 1998 to 2001 with a parallel increase in macrolide and multidrug resistance.Penicillin resistance was associated with macrolide resistance.

View Article: PubMed Central - PubMed

Affiliation: Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel.

ABSTRACT
We investigated the association between prescribing antimicrobial agents and antimicrobial resistance of Streptococcus pneumoniae among children with acute otitis media in southern Israel. During a 6-year period, all prescriptions of a sample of approximately 20% of Jewish and Bedouin children <5 years of age were recorded and all pneumococcal isolates from middle ear fluid were collected. Although antimicrobial drug use was significantly higher in Bedouin children, the proportion of S. pneumoniae isolates with penicillin MIC = or > 1.0 microg/mL was significantly higher in Jewish children. In both populations, antimicrobial prescriptions were markedly reduced over time, especially for penicillins and erythromycin. In contrast, azithromycin prescriptions increased from 1998 to 2001 with a parallel increase in macrolide and multidrug resistance. Penicillin resistance was associated with macrolide resistance. These findings strongly suggest that azithromycin affects increased antimicrobial resistance, including multidrug resistance, in S. pneumoniae.

Show MeSH
Related in: MedlinePlus