Prevalence of nasopharyngeal antibiotic-Resistant pneumococcal carriage in children atending private paediatric practices in Johannesburg

  • Robin E Huebner
  • Avril D Wasas
  • Keith P Klugman
  • W De Wilt
  • E Gottlich
  • M Greeff
  • K Heimann
  • R Heitner
  • M Hopp
  • E Maraschin
  • D Richard

Abstract

Objectives: To determine the nasopharyngeal carriage rate, serogroups/types, and antibiotic resistance of Streptococcus pneumoniae in epildren attending paediatric practices in the private sector in Johannesburg and to relate patterns of resistance to antimicrobial exposure and other demographic characteristics in individual children. Design: A total of 303 children aged from 1 month to 5 years were recruited from eight private paediatric practices in northern Johannesburg. Nasopharyngeal samples were taken and parent interviews were conducted.  Results: Pneumococci were isolated from 121 children (40%). The most common serotypes were 6B, 19F, 6A,23F, 14, and 19A. Carriage was significantly associated with prior hospital admission (odds ratio 1.89) and day care attendance (odds ratio '2.31) and was negatively associated with antibiotic use within the previous 30 days. Antibiotic resistance was found in 84 isolates (69.4%); 45 (37.2%) were multiply resistant. One-third of the pneumococci showed intermediate level resistance to penicillin and 12.4% were highly resistant. There was a high level erythromycin resistance in 38% of the isolates. A total of 94/214 children (42%) had recently used antibiotics and were four times more likely to carry antibiotic-resistant pneumococci (P < 0.05). Conclusion: Pneumococcal resistance was significant in this group of children with easy access to paediatric services and antibiotic use. The implication of such high resistance for the treatment of pneumococcal diseases is that high-dose amoxicillin is the preferred empirical oral therapy for  treatment of otitis media. Ceftriaxone or cefotaxime should be used in combination with vancomycin for the treatment of meningitis until a cephalosporin-resistant pneumococcal cause is excluded. Intravenous penicillin or ampicillin will successfully treat pneumococcal pneumonia in this population. Antimicrobial resistance among pneumococci colonising children in the private sector has increased dramatically in recent years.

S Afr Med J 2000; 90: 1116-1121

Author Biographies

Robin E Huebner
Medical Research Council/South African Inshtille for Medical Research/University of the Witwatersrand Pneumococcal Diseases Research Unit, Johannesburg
Avril D Wasas
Medical Research Council/South African Inshtille for Medical Research/University of the Witwatersrand Pneumococcal Diseases Research Unit, Johannesburg
Keith P Klugman
Medical Research Council/South African Inshtille for Medical Research/University of the Witwatersrand Pneumococcal Diseases Research Unit, Johannesburg
W De Wilt
Paediatric Study Group
E Gottlich
Paediatric Study Group
M Greeff
Paediatric Study Group
K Heimann
Paediatric Study Group
R Heitner
Paediatric Study Group
M Hopp
Paediatric Study Group
E Maraschin
Paediatric Study Group
D Richard
Paediatric Study Group
Published
2017-06-13
Section
Articles

Journal Identifiers


eISSN: 0256-95749
print ISSN: 2078-5135