title: Increased carriage of trimethoprim/sulfamethoxazole-resistant Streptococcus pneumoniae in Malawian children after treatment for malaria with sulfadoxine/pyrimethamine.
abstract: 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.
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. drf0@cdc.gov
authors.forename: D R
authors.initials: DR
authors.lastname: Feikin
authors.forename: S F
authors.initials: SF
authors.lastname: Dowell
authors.forename: O C
authors.initials: OC
authors.lastname: Nwanyanwu
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
authors.forename: P N
authors.initials: PN
authors.lastname: Kazembe
authors.forename: L M
authors.initials: LM
authors.lastname: Barat
authors.forename: C
authors.initials: C
authors.lastname: Graf
authors.forename: P B
authors.initials: PB
authors.lastname: Bloland
authors.forename: C
authors.initials: C
authors.lastname: Ziba
authors.forename: R E
authors.initials: RE
authors.lastname: Huebner
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013413:Sulfadoxine; D011739:Pyrimethamine