title: Impact of intermittent preventive treatment in pregnancy with azithromycin-containing regimens on maternal nasopharyngeal carriage and antibiotic sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a cross-sectional survey at delivery.
abstract: Sulfadoxine-pyrimethamine (SP) plus azithromycin (AZ) (SPAZ) has the potential for intermittent preventive treatment of malaria in pregnancy (IPTp), but its use could increase circulation of antibiotic-resistant bacteria associated with severe pediatric infections. We evaluated the effect of monthly SPAZ-IPTp compared to a single course of SP plus chloroquine (SPCQ) on maternal nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus at delivery among 854 women participating in a randomized controlled trial in Papua New Guinea. Serotyping was performed, and antibiotic susceptibility was evaluated by disk diffusion and Etest. Potential risk factors for carriage were examined. Nasopharyngeal carriage at delivery of S. pneumoniae (SPAZ, 7.2% [30/418], versus SPCQ, 19.3% [84/436]; P<0.001) and H. influenzae (2.9% [12/418] versus 6.0% [26/436], P=0.028), but not S. aureus, was significantly reduced among women who had received SPAZ-IPTp. The number of macrolide-resistant pneumococcal isolates was small but increased in the SPAZ group (13.3% [4/30], versus SPCQ, 2.2% [2/91]; P=0.033). The proportions of isolates with serotypes covered by the 13-valent pneumococcal conjugate vaccine were similar (SPAZ, 10.3% [3/29], versus SPCQ, 17.6% [16/91]; P=0.352). Although macrolide-resistant isolates were rare, they were more commonly detected in women who had received SPAZ-IPTp, despite the significant reduction of maternal carriage of S. pneumoniae and H. influenzae observed in this group. Future studies on SPAZ-IPTp should evaluate carriage and persistence of macrolide-resistant S. pneumoniae and other pathogenic bacteria in both mothers and infants and assess the clinical significance of their circulation.
authors: Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Australia Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Holger W
authors: HW
authors: Unger
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Celestine
authors: C
authors: Aho
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Maria
authors: M
authors: Ome-Kaius
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Regina A
authors: RA
authors: Wangnapi
authors: Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Australia Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Alexandra J
authors: AJ
authors: Umbers
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Wanda
authors: W
authors: Jack
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Alice
authors: A
authors: Lafana
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Audrey
authors: A
authors: Michael
authors: Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Australia.
authors: Sarah
authors: S
authors: Hanieh
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors: Peter
authors: P
authors: Siba
authors: Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain Department of Medical Biology, The University of Melbourne, Parkville, Australia.
authors: Ivo
authors: I
authors: Mueller
authors: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea School of Applied and Biomedical Sciences, Federation University, Churchill, Australia.
authors: Andrew R
authors: AR
authors: Greenhill
authors: Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Australia sroger@unimelb.edu.au.
authors: Stephen J
authors: SJ
authors: Rogerson
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods*; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology*; D010219:Papua New Guinea; D011247:Pregnancy; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use; D012703:Serotyping; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013413:Sulfadoxine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D017963:Azithromycin; D013413:Sulfadoxine; D011739:Pyrimethamine