Reduction of antibiotic use in the community reduces the rate of colonization with penicillin G-nonsusceptible Streptococcus pneumoniae.
BACKGROUND
There is a lack of evidence documenting the impact of optimized antibiotic use on the rates of colonization with penicillin G-nonsusceptible Streptococcus pneumoniae (PNSP) in children. This study evaluates the effect of community-based intervention strategies on the prevalence of pnsp colonization.


METHODS
A controlled, population-based pharmacoepidemiological trial was conducted from January through May 2000. Three French geographic areas were selected on the basis of demographic similarities. Two intervention strategies were implemented: (1) reduced antibiotic use, which was achieved by not prescribing antibiotics for presumed viral respiratory tract infections (the prescription-reduction group); and (2) better adaptation of dose and duration (the dose/duration group). A control group received no intervention. The target population was children aged 3-6 years who were attending kindergarten. Oropharyngeal pneumococcus colonization and antibiotic use were monitored throughout the 5-month study.


RESULTS
The prescription-reduction, dose/duration, and control groups included 601, 483, and 405 children, respectively. The interventions induced significantly larger decreases in antibiotic use in the prescription-reduction group (-18.8%) and dose/duration group (-17.1%) than in the control group (-3.8%), and the rates of PNSP colonization were initially similar for the 3 groups (52.5%, 55.1%, and 50.0%, respectively). At the end of the 5-month study, the rates of PNSP colonization were 34.5% for the prescription-reduction group (P=.05) and 44.3% for the dose/duration group (P=.8), compared with 46.2% for the control group.


CONCLUSIONS
Intensive educational strategies aimed at optimizing antibiotic use can significantly reduce the rate of PNSP colonization in areas with high resistance rates.
Guillemot
Didier
D
Centre de Resource en Biostatistiques, Epidémiologie et Pharmacoépidemiologie, Institut Pasteur, Unit 657, INSERM, France. guillemo@pasteur.fr
Varon
Emmanuelle
E
Bernède
Claire
C
Weber
Philippe
P
Henriet
Laurence
L
Simon
Sylvie
S
Laurent
Cécile
C
Lecoeur
Hervé
H
Carbon
Claude
C
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002353:Carrier State / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D010400:Penicillin G / Q000494:pharmacology*; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D010818:Practice Patterns, Physicians'; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D010400:Penicillin G