Increased carriage of trimethoprim/sulfamethoxazole-resistant Streptococcus pneumoniae in Malawian children after treatment for malaria with sulfadoxine/pyrimethamine.
Treatment of malaria with sulfadoxine/pyrimethamine and of presumed bacterial infections with trimethoprim/sulfamethoxazole (cotrimoxazole) was assessed to see if either increases the carriage of cotrimoxazole-resistant Streptococcus pneumoniae in Malawian children. Children <5 years old treated with sulfadoxine/pyrimethamine, cotrimoxazole, or no antimicrobial agent were enrolled in a prospective observational study. Nasopharyngeal swabs were taken before treatment and 1 and 4 weeks later. Pneumococci were tested for antibiotic susceptibility by broth microdilution. In sulfadoxine/pyrimethamine-treated children, the proportion colonized with cotrimoxazole-nonsusceptible pneumococci increased from 38.1% at the initial visit to 44.1% at the 4-week follow-up visit (P=.048). For cotrimoxazole-treated children, the proportion colonized with cotrimoxazole-nonsusceptible pneumococci increased from 41.5% at the initial visit to 52% at the 1-week follow-up visit (P=.0017) and returned to 41.7% at the 4-week follow-up. Expanding use of sulfadoxine/pyrimethamine to treat chloroquine-resistant malaria may have implications for national pneumonia programs in developing countries where cotrimoxazole is widely used.
Feikin
D R
DR
Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. drf0@cdc.gov
Dowell
S F
SF
Nwanyanwu
O C
OC
Klugman
K P
KP
Kazembe
P N
PN
Barat
L M
LM
Graf
C
C
Bloland
P B
PB
Ziba
C
C
Huebner
R E
RE
Schwartz
B
B
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D002353:Carrier State; D002648:Child; D004198:Disease Susceptibility; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000378:metabolism; D008295:Malawi; D008297:Male; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use*; D013296:Streptococcus pneumoniae / Q000187:drug effects; D013413:Sulfadoxine / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013413:Sulfadoxine; D011739:Pyrimethamine