title: High nasopharyngeal carriage of drug resistant Streptococcus pneumoniae and Haemophilus influenzae in North Indian schoolchildren.
abstract: OBJECTIVE
  To determine the carriage rate of Streptococcus pneumoniae and Haemophilus influenzae in healthy Indian schoolchildren. The prevalence of antibiotic resistant strains in the community may be used to assess the trends of antibiotic resistance in invasive strains. Prevalence of resistance to various antimicrobial drugs among S. pneumoniae and H. influenzae was estimated.
  
  
  METHODS
  Two thousand four hundred subjects, aged 5-10 years, were enrolled from 45 rural and 45 urban schools. A nasopharyngeal swab was collected from each child, after taking informed written consent. Swabs were processed to isolate S. pneumoniae and H. influenzae. All isolates were tested for resistance to chloramphenicol, erythromycin and co-trimoxazole. Streptococcus pneumoniae isolates were also tested against tetracycline and oxacillin while H. influenzae isolates were tested against ampicillin.
  
  
  RESULTS
  Nasopharyngeal carriage of S. pneumoniae and H. influenzae was high in healthy schoolchildren. Stratified analysis showed that nasal carriage of pneumococci in urban children was significantly lower than in rural children [46.8% vs. 53.2%, P<0.001]. Carriage rates of H. influenzae in male and female populations were significantly different (47.8% vs. 52.3%, P<0.04). Penicillin resistance in S. pneumoniae was found low (3.3%), but 22.9% of H. influenzae isolates were ampicillin resistant. Resistance to co-trimoxazole was very high in both S. pneumoniae (81.8%) and H. influenzae (67.3%).
  
  
  CONCLUSIONS
  There is high nasopharyngeal carriage of drug resistant S. pneumoniae and H. influenzae in schoolchildren of north India. Currently, in India, co-trimoxazole for 5 days is recommended for treatment of non-severe pneumonia and third generation cephalosporins are drug of choice for management of severe pneumococcal/H. influenzae diseases. We found high co-trimoxazole resistance and low penicillin resistance in pneumococcal isolates. This justifies empirical use of penicillin in management of invasive pneumococcal infections in India.
authors.affiliation: Department of Microbiology, King George's Medical University, Lucknow, India. amita602002@yahoo.com
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kumar
authors.forename: Shally
authors.initials: S
authors.lastname: Awasthi
mesh_terms: D002353:Carrier State / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology / Q000382:microbiology; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D012423:Rural Health; D013048:Specimen Handling / Q000379:methods; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D014504:Urban Health
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination