USE OF NASOPHARYNGEAL ISOLATES OF STREPTOCOCCUS-PNEUMONIAE AND HAEMOPHILUS-INFLUENZAE FROM CHILDREN IN PAKISTAN FOR SURVEILLANCE FOR ANTIMICROBIAL RESISTANCE

Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus i nfluenzae presents a challenge to clinical case management, particular ly in Programs for acute respiratory tract infection (ARI), including pneumonia, in developing countries. To determine whether nasopharyngea l isolates of S. pneumoniae and H. influenzae from a clinically define d group of children could be used to predict the prevalence of antimic robial resistance of strains that cause disease, 601 urban children wi th ARI, 133 healthy urban children and 285 rural children were evaluat ed in Pakistan. Of the urban children with ARI. 216 (35.9% were bacter emic, predominantly with S. pneumoniae (108 children) and H. influenza e (100 children). Overall 631 (61.9%) children carried S. pneumoniae a nd 381 (37.4%) carried H. influenzae. The proportions of nasopharyngea l isolates of both organisms from urban children with ARI resistant to penicillin or ampicillin, trimethoprim/sulfamethoxazole, chlorampheni col and erythromycin were similar to the proportions of resistant bloo d isolates. Nasopharyngeal isolates from rural children had lower rate s of resistance to some antimicrobial agents. These findings suggest t hat nasopharyngeal isolates of S. pneumoniae and H. influenzae from ch ildren with ARI can be used to conduct surveillance for antimicrobial resistance in a defined geographic area. Such surveillance would aid p rograms in developing countries in making a rational choice of antimic robial agents for use in clinical management of bacterial diseases, in cluding pneumonia.