title: Pattern of antibiotic use in a trachoma-endemic region of Nepal: implications for mass azithromycin distribution.
abstract: OBJECTIVE
  To investigate antibiotic utilization in a rural district of western Nepal that is currently receiving azithromycin as part of a trachoma program and is being monitored by the Centers for Disease Control and Prevention (CDC) for drug resistance.
  
  
  METHODS
  Antibiotic purchase receipts were collected for 3 months from all medicine halls, pharmacies, and government sub-health posts in a sub-district of Western Nepal. Supplementary surveys of antibiotic sales were performed in different seasons.
  
  
  RESULTS
  Macrolides account for 3.9% of total antibiotic use, far less than quinolones, penicillins, tetracyclines, and sulfonamides.
  
  
  CONCLUSIONS
  If trachoma programs in Western Nepal generate transient macrolide resistance in pneumococcus and other bacteria, the epidemiological impact may not be great, as macrolides are not commonly used in the area.
authors.affiliation: F.I. Proctor Foundation and the Department of Ophthalmology, University of California at San Francisco, 94143-0944, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Schiedler
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Bhatta
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Miao
authors.forename: Mariko
authors.initials: M
authors.lastname: Bird
authors.forename: Hem
authors.initials: H
authors.lastname: Jha
authors.forename: J S P
authors.initials: JS
authors.lastname: Chaudary
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D017723:Drug Utilization Review; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D012424:Rural Population / Q000706:statistics & numerical data; D014141:Trachoma / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin