title: Antibiotic resistance in Streptococcus pneumoniae isolated from children.
abstract: OBJECTIVE
  To determine the level of antibiotic resistance in pneumoniae (S. pneumoniae) isolated from nasal swabs of healthy children.
  
  
  METHODS
  Cross-sectional community survey.
  
  
  METHODS
  Survey was undertaken in general practice settings in Canberra during March and April 1998.
  
  
  METHODS
  Four hundred and sixty-one children under 3 years of age enrolled in general practice trial of clinical practice guidelines for antibiotic use.
  
  
  METHODS
  Resistance to penicillin, erythromycin, co-trimoxazole, tetracycline, chloramphenicol and cefotaxime among the isolates of S. pneumoniae.
  
  
  RESULTS
  A total of 461 nasal swabs were collected and S. pneumoniae was isolated from 171 (37.1%). Penicillin resistance was found in 12.3% of these isolates, with high level resistance in 0.6%. Resistance rates were higher for cotrimoxazole (44.4%) and erythromycin (18.1%) than for penicillin. Multidrug resistance was found in 19% of these isolates. There was a significant association between the attendance at a day care centre and carriage of pneumococcus (53% vs 32%, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7, P < 0.001). Children who attended day care centers and had received antibiotics during the 4 months prior to swab collection were three times more likely to carry an antibiotic-resistant isolate than children who had neither attended a day care centre nor received antibiotics (68% vs 40%, OR 3.1, 95% CI 1.2-8.4, P = 0.02).
  
  
  CONCLUSIONS
  The level of antibiotic resistance in pneumococci from healthy children was of concern. Carriage of pneumococcus was significantly higher in children who attended a day care centre. Resistance was significantly correlated with antibiotic use in combination with day-care attendance. These findings warrant more judicious use of antibiotics in children.
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia. dilruba.nasrin@anu.edu.au
authors.forename: D
authors.initials: D
authors.lastname: Nasrin
authors.forename: P J
authors.initials: PJ
authors.lastname: Collignon
authors.forename: E J
authors.initials: EJ
authors.lastname: Wilson
authors.forename: L S
authors.initials: LS
authors.lastname: Pilotto
authors.forename: R M
authors.initials: RM
authors.lastname: Douglas
mesh_terms: D002439:Cefotaxime / Q000494:pharmacology; D002675:Child, Preschool; D002701:Chloramphenicol / Q000494:pharmacology; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004917:Erythromycin / Q000494:pharmacology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016017:Odds Ratio; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000188:drug therapy*; D015995:Prevalence; D012307:Risk Factors; D013021:South Australia / Q000453:epidemiology; D018709:Statistics, Nonparametric; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D013752:Tetracycline / Q000494:pharmacology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology
chemical_list: D010406:Penicillins; D004917:Erythromycin; D002701:Chloramphenicol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013752:Tetracycline; D002439:Cefotaxime