A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae
A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae
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DOI：
10.1093/clinids/24.3.356
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发表时间：
1997-03-01
影响因子：
11.8
通讯作者：
Mathews, JD
中科院分区：
文献类型：
--
作者：
Leach, AJ;ShelbyJames, TM;Mathews, JD
1995年2月，向沙眼患儿及其家庭接触者（儿童）给予单剂量阿奇霉素。对于沙眼儿童，阿奇霉素治疗前即刻和治疗后2-3周、2个月和6个月的肺炎球菌携带率分别为68%（54/79）、29%（11/38）、78%（29/37）和87%（34/39）。在治疗前，携带阿奇霉素耐药肺炎链球菌菌株的携带阳性儿童的比例为1/54（1.9%），随后在随访时为6/11（54.5%），10/29（34.5%）和2/34（5.9%）。阿奇霉素治疗后，肺炎球菌血清型发生变化。从1/79份治疗前拭子标本（1.3%）、治疗后2个月内采集的16/75份拭子标本（21.3%）和治疗后6个月采集的2/32份拭子标本（6%）中分离出阿奇霉素耐药菌株（血清型10 F、23 A和45）。数学模型显示，阿奇霉素耐药的肺炎球菌菌株在以前的殖民儿童比以前noncolonized儿童更快的外观。因此，似乎阿奇霉素的选择性作用允许预先存在的阿奇霉素耐药菌株的生长和传播。需要更多的研究来阐明阿奇霉素使用的临床相关性和影响。
In February 1995, single-dose azithromycin was given to children with trachoma and their household contacts who were children. For children with trachoma, rates of carriage of pneumococci immediately before treatment with azithromycin and 2-3 weeks, 2 months, and 6 months after treatment were 68% (54 of 79), 29% (11 of 38), 78% (29 of 37), and 87% (34 of 39), respectively. The proportion of carriage-positive children with azithromycin-resistant Streptococcus pneumoniae strains was 1 of 54 (1.9%) before treatment and then 6 of 11 (54.5%), 10 of 29 (34.5%), and 2 of 34 (5.9%) at follow-up visits. The profile of pneumococcal serotypes changed after azithromycin treatment. Azithromycin-resistant strains (serotypes 10F, 23A, and 45) were isolated from 1 (1.3%) of 79 pretreatment swab specimens, from 16 (21.3%) of 75 swab specimens collected up to 2 months after treatment, and from 2 (6%) of 32 obtained 6 months after treatment. Mathematical modeling showed a more rapid appearance of azithromycin-resistant pneumococcal strains in previously colonized children than in previously noncolonized children. Thus, it appears that the selective effect of azithromycin allowed the growth and transmission of preexisting azithromycin-resistant strains. More research is needed to clarify the clinical relevance and implications of azithromycin use.