title: Antimicrobial resistance of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in the Central African Republic.
abstract: BACKGROUND
  To assist the Central African Republic (CAR) develop national guidelines for treating children with pneumonia, a survey was conducted to determine antimicrobial resistance rates of nasopharyngeal isolates of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI). Secondary purposes of the survey were to identify risk factors associated with carriage of a resistant isolate and to compare the survey methods of including only children with pneumonia vs. including all ill children.
  
  
  METHODS
  A cross-sectional survey of 371 ill children was conducted at 2 outpatient clinics in Bangui, CAR.
  
  
  RESULTS
  In all 272 SP isolates and 73 HI isolates were cultured. SP resistance rates to penicillin, trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline and chloramphenicol were 8.8, 6.3, 42.3 and 9.2%, respectively. All penicillin-resistant SP isolates were intermediately resistant. HI resistance rates to ampicillin, TMP-SMX and chloramphenicol were 1.4, 12.3 and 0%, respectively. The most common SP serotypes/groups were 19, 14, 6 and 1; 49% of HI isolates were type b. History of antimicrobial use in the previous 7 days was the only factor associated with carriage of a resistant isolate. Resistance rates were similar among ill children regardless of whether they had pneumonia.
  
  
  CONCLUSIONS
  Resistance rates were low for antimicrobials recommended by the World Health Organization for children with pneumonia. We recommended TMP-SMX as the first line treatment for pneumonia in CAR because of its low cost, ease of dosing and activity against malaria.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. axr9@cdc.gov
authors.forename: A K
authors.initials: AK
authors.lastname: Rowe
authors.forename: M S
authors.initials: MS
authors.lastname: Deming
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: A
authors.initials: A
authors.lastname: Wasas
authors.forename: D
authors.initials: D
authors.lastname: Rolka
authors.forename: H
authors.initials: H
authors.lastname: Rolka
authors.forename: J
authors.initials: J
authors.lastname: Ndoyo
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D002488:Central African Republic / Q000453:epidemiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination