Topical ocular antibiotics induce bacterial resistance at extraocular sites.
OBJECTIVE
To compare the prevalence of antibiotic resistance found in nasopharyngeal Streptococcus pneumoniae between villages treated with topical tetracycline or systemic azithromycin as part of a trachoma control programme.


METHODS
All children aged 1-10 years were offered either single dose oral azithromycin treatment (20 mg/kg) or a course of topical 1% tetracycline ointment, depending on the area. Treatment was given annually for 3 years. Six months after the third annual treatment in each village, children were surveyed for nasopharyngeal carriage of S pneumoniae and resistance was determined using broth dilution MIC technique. Children in two additional villages, which had not yet been treated, were also surveyed.


RESULTS
Nasopharyngeal carriage of S pneumoniae was similar in the tetracycline treated, azithromycin treated, and untreated areas (p=0.57). However, resistance to tetracycline and azithromycin was distributed differently between the three areas (p=0.004). The village treated with topical tetracycline had a higher prevalence of tetracycline resistance than the other villages (p=0.010), while the oral azithromycin treated village had a higher prevalence of macrolide resistance than the other villages (p=0.014).


CONCLUSIONS
Annual mass treatment with oral azithromycin may alter the prevalence of drug resistant S pneumoniae in a community. Surprisingly, topical tetracycline may also increase nasopharyngeal pneumococcal resistance. Topical antibiotics may have an effect on extraocular bacterial resistance.
Gaynor
B D
BD
Department of Ophthalmology, F I Proctor Foundation, 95 Kirkham Street, Room 307, University of California San Francisco, San Francisco, CA 94143-0944, USA.
Chidambaram
J D
JD
Cevallos
V
V
Miao
Y
Y
Miller
K
K
Jha
H C
HC
Bhatta
R C
RC
Chaudhary
J S P
JS
Osaki Holm
S
S
Whitcher
J P
JP
Holbrook
K A
KA
Fry
A M
AM
Lietman
T M
TM
D000284:Administration, Oral; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009302:Nasopharyngeal Diseases / Q000382:microbiology; D009305:Nasopharynx / Q000382:microbiology*; D009390:Nepal; D009824:Ointments; D013296:Streptococcus pneumoniae / Q000187:drug effects; D013752:Tetracycline / Q000008:administration & dosage* / Q000627:therapeutic use; D013753:Tetracycline Resistance; D013997:Time Factors; D014141:Trachoma / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D009824:Ointments; D017963:Azithromycin; D013752:Tetracycline