title: Antibiotic Resistance in Streptococcus pneumoniae after Azithromycin Distribution for Trachoma.
abstract: Trachoma is caused by Chlamydia trachomatis and is a leading cause of blindness worldwide. Mass distribution of azithromycin (AZM) is part of the strategy for the global elimination of blinding trachoma by 2020. Although resistance to AZM in C. trachomatis has not been reported, there have been concerns about resistance in other organisms when AZM is administered in community settings. We identified studies that measured pneumococcal prevalence and resistance to AZM following mass AZM provision reported up to 2013 in Medline and Web of Science databases. Potential sources of bias were assessed using the Cochrane Risk of Bias Tool. A total of 45 records were screened, of which 8 met the inclusion criteria. We identified two distinct trends of resistance prevalence, which are dependent on frequency of AZM provision and baseline prevalence of resistance. We also demonstrated strong correlation between the prevalence of resistance at baseline and at 2-3 months (r = 0.759). Although resistance to AZM in C. trachomatis has not been reported, resistance to this commonly used macrolide antibiotic in other diseases could compromise treatment. This should be considered when planning long-term trachoma control strategies.
authors.affiliation: Department of Ophthalmology, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent TN24 0LZ, UK.
authors.forename: Derek K-H
authors.initials: DK
authors.lastname: Ho
authors.affiliation: Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, ON, Canada M5G 1E2.
authors.forename: Christian
authors.initials: C
authors.lastname: Sawicki
authors.affiliation: School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Grassly