Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study.
OBJECTIVE
To study the correlation of antimicrobial consumption with the carriage rate of penicillin resistant and multiresistant pneumococci in children.


METHODS
Cross sectional and analytical prevalence study.


METHODS
Five different communities in Iceland.


METHODS
Prevalence of nasopharyngeal carriage of penicillin resistant pneumococci in children aged under 7 years in relation to antibiotic use as determined by information from parents, patient's records, and total sales of antimicrobials from local pharmacies in four study areas.


RESULTS
Total antimicrobial sales for children (6223 prescriptions) among the four areas for which data were available ranged from 9.6 to 23.2 defined daily doses per 1000 children daily (1.1 to 2.6 courses yearly per child). Children under 2 consumed twice as much as 2-6 year olds (20.5 v 10.9 defined daily doses per 1000 children daily). Nasopharyngeal specimens were obtained from 919 children, representing 15-38% of the peer population groups in the different areas. Pneumococci were carried by 484 (52.7%) of the children, 47 (9.7%) of the isolates being resistant to penicillin or multiresistant. By multivariate analysis age (< 2 years), area (highest antimicrobial consumption), and individual use of antimicrobials significantly influenced the odds of carrying penicillin resistant pneumococci. By univariate analysis, recent antimicrobial use (two to seven weeks) and use of co-trimoxazole were also significantly associated with carriage of penicillin resistant pneumococci.


CONCLUSIONS
Antimicrobial use, with regard to both individual use and total antimicrobial consumption in the community, is strongly associated with nasopharyngeal carriage of penicillin resistant pneumococci in children. Control measures to reduce the prevalence of penicillin resistant pneumococci should include reducing the use of antimicrobials in community health care.
Arason
V A
VA
Department of Family Medicine, Sólvangur Health Centre, University of Iceland, Hafnarfjördur, Iceland.
Kristinsson
K G
KG
Sigurdsson
J A
JA
Stefánsdóttir
G
G
Mölstad
S
S
Gudmundsson
S
S
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009302:Nasopharyngeal Diseases / Q000453:epidemiology*; D009305:Nasopharynx / Q000382:microbiology; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology*; D015995:Prevalence; D012111:Residence Characteristics; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination