title: Antibiotic non-susceptibility among Streptococcus pneumoniae and Haemophilus influenzae isolates identified in African cohorts: a meta-analysis of three decades of published studies.
abstract: Management of community-acquired pneumonia caused by Streptococcus pneumoniae and Haemophilus influenzae type B (Hib) can be complicated by emerging antimicrobial non-susceptibility. We conducted a meta-analysis to examine the antibiotic susceptibility of community-acquired invasive infections with S. pneumoniae and Hib in Africa from 1978 to 2011. With the notable exceptions of widespread trimethoprim/sulfamethoxazole (SXT) and tetracycline non-susceptibility, the majority of pneumococci remain susceptible to ampicillin/amoxicillin. However, 23.8% of pneumococcal meningitis isolates are non-susceptible to penicillin. Similarly, Hib isolates show non-susceptibility to SXT, tetracycline, erythromycin and chloramphenicol. β-Lactamase production among Hib isolates is increasing, a new observation for Africa, but is mitigated somewhat by Hib vaccination scale-up. In summary, pneumococcal susceptibility to amoxicillin remains high throughout Africa, and amoxicillin can be effectively and safely used as first-line treatment for childhood pneumonia. Data support first-line treatment of bacterial meningitis with ceftriaxone or cefotaxime.
authors.affiliation: PATH, P.O. Box 900922, Seattle, WA 98109, USA. Electronic address: aginsburg@path.org.
authors.forename: Amy Sarah
authors.initials: AS
authors.lastname: Ginsburg
authors.forename: Laura
authors.initials: L
authors.lastname: Tinkham
authors.forename: Katherine
authors.initials: K
authors.lastname: Riley
authors.forename: Noa A
authors.initials: NA
authors.lastname: Kay
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gill
mesh_terms: D000349:Africa; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D006192:Haemophilus Infections / Q000188:drug therapy / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: Africa; Antibiotic non-susceptibility; Haemophilus influenzae; Pneumonia; Streptococcus pneumoniae