title: Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomized trial.
abstract: BACKGROUND
  Emerging drug resistance threatens the effectiveness of existing therapies for pneumococcal infections. Modifying the dose and duration of antibiotic therapy may limit the spread of resistant pneumococci.
  
  
  OBJECTIVE
  To determine whether short-course, high-dose amoxicillin therapy reduces risk of posttreatment resistant pneumococcal carriage among children with respiratory tract infections.
  
  
  METHODS
  Randomized trial conducted in an outpatient clinic in Santo Domingo, Dominican Republic, October 1999 through July 2000.
  
  
  METHODS
  Children aged 6 to 59 months who were receiving antibiotic prescriptions for respiratory tract illness (n = 795).
  
  
  METHODS
  Children were randomly assigned to receive 1 of 2 twice-daily regimens of amoxicillin: 90 mg/kg per day for 5 days (n = 398) or 40 mg/kg per day for 10 days (n = 397).
  
  
  METHODS
  Penicillin-nonsusceptible Streptococcus pneumoniae carriage, assessed in nasopharyngeal specimens collected at days 0, 5, 10, and 28; baseline risk factors for nonsusceptible pneumococcal carriage; and adherence to regimen, compared between the 2 groups.
  
  
  RESULTS
  At the day 28 visit, risk of penicillin-nonsusceptible pneumococcal carriage was significantly lower in the short-course, high-dose group (24%) compared with the standard-course group (32%); relative risk (RR), 0.77; 95% confidence interval (CI), 0.60-0.97; P =.03; risk of trimethoprim-sulfamethoxazole nonsusceptibility was also lower in the short-course, high-dose group (RR, 0.77; 95% CI, 0.58-1.03; P =.08). The protective effect of short-course, high-dose therapy was stronger in households with 3 or more children (RR, 0.72; 95% CI, 0.52-0.98). Adherence to treatment was higher in the short-course, high-dose group (82% vs 74%; P =.02).
  
  
  CONCLUSIONS
  Short-course, high-dose outpatient antibiotic therapy appears promising as an intervention to minimize the impact of antibiotic use on the spread of drug-resistant pneumococci.
authors: Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, MS C23, 1600 Clifton Rd, Atlanta, GA 30333, USA. zha6@cdc.gov
authors: S J
authors: SJ
authors: Schrag
authors: C
authors: C
authors: Peña
authors: J
authors: J
authors: Fernández
authors: J
authors: J
authors: Sánchez
authors: V
authors: V
authors: Gómez
authors: E
authors: E
authors: Pérez
authors: J M
authors: JM
authors: Feris
authors: R E
authors: RE
authors: Besser
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002353:Carrier State / Q000188:drug therapy*; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology; D010406:Penicillins / Q000008:administration & dosage* / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy*; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination