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High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study
Makerere University School of Public Health, Kampala, Uganda.
Abt Associates, Kampala, Uganda.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
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2015 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 4, 249-256 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2015. Vol. 120, no 4, 249-256 p.
Keyword [en]
Antibiotic resistance; children; community case management; pneumonia; Streptococcus pneumoniae
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-261881DOI: 10.3109/03009734.2015.1072606ISI: 000365684900004PubMedID: 26305429OAI: oai:DiVA.org:uu-261881DiVA: diva2:851432
Sida - Swedish International Development Cooperation Agency
Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2016-01-11Bibliographically approved

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