Antibiotic resistance of nasopharyngeal isolates of Streptococcus pneumoniae from children in Lesotho

Villages associated with the Lesotho Highlands Development Agency were rand omized with a bias in favour of larger villages, and children <5 years of a ge from cluster-randomized households in these villages were chosen for the assessment of antibiotic resistance in pneumococci. Children of the same a ge group attending clinics in the capital, Maseru, were selected for compar ison. Nasopharyngeal cultures of Streptococcus pneumoniae from both groups of children were examined for antibiotic resistance and a questionnaire was used to assess risk factors for the acquisition of resistant strains. Carriage of penicillin- and tetracycline-resistant pneumococci was signific antly higher among 196 Maseru children compared with 324 rural children (P < 0.05 and P = 0.01, respectively). Maseru children tended to visit clinics at an earlier age compared with their rural counterparts. The rural childr en were less exposed to antibiotics (P < 0.01), were less frequently hospit alized (P < 0.001), and rarely attended daycare centres (P < 0.001). The ve ry low incidence of antibiotic resistance in rural Lesotho and the higher i ncidence in Maseru are in stark contrast with the much higher frequencies f ound in the Republic of South Africa, many European countries, and the USA.