title: High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study.
abstract: BACKGROUND
  In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia--often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics.
  
  
  METHODS
  In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test.
  
  
  RESULTS
  Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates had intermediate resistance to penicillin, none was highly resistant. Whereas no isolate was resistant to erythromycin, 98.9% were resistant to trimethoprim-sulphamethoxazole (co-trimoxazole).
  
  
  CONCLUSIONS
  In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. To inform treatment policies on the clinical efficacy of current treatment protocols for pneumonia in health facilities and at the community level, routine surveillance of resistance in pneumonia pathogens is needed as well as research on treatment efficacy in cases with resistant strains. Improved clinical algorithms and diagnostics for pneumonia should be developed.
authors: a Makerere University School of Public Health , Kampala , Uganda .
authors: Elizeus
authors: E
authors: Rutebemberwa
authors: b Abt Associates , Kampala , Uganda .
authors: Betty
authors: B
authors: Mpeka
authors: c Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , United States .
authors: George
authors: G
authors: Pariyo
authors: a Makerere University School of Public Health , Kampala , Uganda .|d Division of Global Health, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden .|e International Maternal and Child Health Unit, Department of Woman and Child Health , Uppsala University , Sweden .
authors: Stefan
authors: S
authors: Peterson
authors: f Department of Paediatrics and Child Health , Makerere University Medical School , Kampala , Uganda .
authors: Edison
authors: E
authors: Mworozi
authors: g Department of Microbiology , Makerere University Faculty of Medicine , Kampala , Uganda , and.
authors: Freddie
authors: F
authors: Bwanga
authors: a Makerere University School of Public Health , Kampala , Uganda .|d Division of Global Health, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden .|h Malaria Consortium , London , United Kingdom.
authors: Karin
authors: K
authors: Källander
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D006801:Humans; D007223:Infant; D008403:Mass Screening / Q000379:methods; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D014454:Uganda / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Streptococcus pneumoniae; children; community case management; pneumonia