Impact of mass administration of azithromycin as a preventive treatment on the prevalence and resistance of nasopharyngeal carriage of Staphylococcus aureus

• Published in: PloS one Vol. 16; no. 10; p. e0257190
• Main Authors: Hema-Ouangraoua, Soumeya, Tranchot-Diallo, Juliette, Zongo, Issaka, Kabore, Nongodo Firmin, Nikièma, Frédéric, Yerbanga, Rakiswende Serge, Tinto, Halidou, Chandramohan, Daniel, Ouedraogo, Georges-Anicet, Greenwood, Brian, Ouedraogo, Jean-Bosco
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.10.2021; Public Library of Science (PLoS)
• Subjects: Amodiaquine; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Antimalarial agents; Antimalarials - administration & dosage; Antimalarials - therapeutic use; Antimicrobial agents; Azithromycin; Azithromycin - administration & dosage; Azithromycin - therapeutic use; Biology and Life Sciences; Child, Preschool; Children; Clinical trials; Complications and side effects; Disease transmission; Drug dosages; Drug resistance; Drug Resistance, Bacterial - drug effects; Female; Hospitals; Households; Humans; Illnesses; Infant; Infections; Laboratories; Malaria; Malaria - prevention & control; Male; Medicine and Health Sciences; Methicillin; Mortality; Nasopharynx - microbiology; Pathogens; Patient admissions; Patient outcomes; Pediatrics; Penicillin; Pharmaceutical industry; Placebos; Prevalence; Prevention; Pyrimethamine; Staphylococcal Infections - diagnosis; Staphylococcal Infections - epidemiology; Staphylococcal Infections - prevention & control; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Staphylococcus aureus infections; Streptococcus infections; Sulfadoxine; Vector-borne diseases; Burkina Faso; Mumbai India; United Kingdom > UK; Mali; Gambia; China; Tanzania; India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0257190

Staphylococcus aureus is a major cause of serious illness and death in children, indicating the need to monitor prevalent strains, particularly in the vulnerable pediatric population. Nasal carriage of S. aureus is important as carriers have an increased risk of serious illness due to systemic invasion by this pathogen and can transmit the infection. Recent studies have demonstrated the effectiveness of azithromycin in reducing the prevalence of nasopharyngeal carrying of pneumococci, which are often implicated in respiratory infections in children. However, very few studies of the impact of azithromycin on staphylococci have been undertaken. During a clinical trial under taken in 2016, nasal swabs were collected from 778 children aged 3 to 59 months including 385 children who were swabbed before administration of azithromycin or placebo and 393 after administration of azithromycin or placebo. Azithromycin was given in a dose of 100 mg for three days, together with the antimalarials sulfadoxine-pyrimethamine and amodiaquine, on four occasions at monthly intervals during the malaria transmission season. These samples were cultured for S. aureus as well as for the pneumococcus. The S. aureus isolates were tested for their susceptibility to azithromycin (15 g), penicillin (10 IU), and cefoxitine (30 g) (Oxoid Ltd). S. aureus was isolated from 13.77% (53/385) swabs before administration of azithromycin and from 20.10% (79/393) six months after administration (PR = 1.46 [1.06; 2.01], p = 0.020). Azithromycin resistance found in isolates of S. aureus did not differ significantly before and after intervention (26.42% [14/53] vs 16.46% [13/79], (PR = 0.62 [0.32; 1.23], p = 0.172). Penicillin resistance was very pronounced, 88.68% and 96.20% in pre-intervention and in post-intervention isolates respectively, but very little Methicillin Resistance (MRSA) was detected (2 cases before and 2 cases after intervention). Monitoring antibiotic resistance in S. aureus and other bacteria is especially important in Burkina Faso due to unregulated consumption of antibiotics putting children and others at risk.