title: Prevalence of nasopharyngeal antibiotic-resistant pneumococcal carriage in children attending private paediatric practices in Johannesburg.
abstract: OBJECTIVE
  To determine the nasopharyngeal carriage rate, serogroups/types, and antibiotic resistance of Streptococcus pneumoniae in children attending paediatric practices in the private sector in Johannesburg and to relate patterns of resistance to antimicrobial exposure and other demographic characteristics in individual children.
  
  
  METHODS
  A total of 303 children aged from 1 month to 5 years were recruited from eight private paediatric practices in northern Johannesburg. Nasopharyngeal samples were taken and parent interviews were conducted.
  
  
  RESULTS
  Pneumococci were isolated from 121 children (40%). The most common serotypes were 6B, 19F, 6A, 23F, 14, and 19A. Carriage was significantly associated with prior hospital admission (odds ratio 1.89) and day care attendance (odds ratio 2.31) and was negatively associated with antibiotic use within the previous 30 days. Antibiotic resistance was found in 84 isolates (69.4%); 45 (37.2%) were multiply resistant. One-third of the pneumococci showed intermediate level resistance to penicillin and 12.4% were highly resistant. There was a high level erythromycin resistance in 38% of the isolates. A total of 94/214 children (42%) had recently used antibiotics and were four times more likely to carry antibiotic-resistant pneumococci (P < 0.05).
  
  
  CONCLUSIONS
  Pneumococcal resistance was significant in this group of children with easy access to paediatric services and antibiotic use. The implication of such high resistance for the treatment of pneumococcal diseases is that high-dose amoxicillin is the preferred empirical oral therapy for treatment of otitis media. Ceftriaxone or cefotaxime should be used in combination with vancomycin for the treatment of meningitis until a cephalosporin-resistant pneumococcal cause is excluded. Intravenous penicillin or ampicillin will successfully treat pneumococcal pneumonia in this population. Antimicrobial resistance among pneumococci colonising children in the private sector has increased dramatically in recent years.
authors.affiliation: Medical Research Council/South African Institute for Medical Research/University, Witwatersrand Pneumococcal Diseases Research Unit, Johannesburg.
authors.forename: R E
authors.initials: RE
authors.lastname: Huebner
authors.forename: A D
authors.initials: AD
authors.lastname: Wasas
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002656:Child Day Care Centers; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004917:Erythromycin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008586:Meningitis, Pneumococcal / Q000188:drug therapy; D009305:Nasopharynx / Q000382:microbiology*; D016017:Odds Ratio; D010343:Patient Admission; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy; D015995:Prevalence; D011331:Private Practice; D012703:Serotyping; D013019:South Africa; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D004917:Erythromycin; D000658:Amoxicillin