Antibiotic resistance in Streptococcus pneumoniae isolated from children

Objective: To determine the level of antibiotic resistance in pneumoniae (S . pneumoniae) isolated from nasal swabs of healthy children. Method: Cross-sectional community survey. Setting: Survey was undertaken in general practice settings in Canberra dur ing March and April 1998. Subjects: Four hundred and sixty-one children under 3 years of age enrolled in a general practice trial of clinical practice guidelines for antibiotic use. Outcome measures: Resistance to penicillin, erythromycin, co-trimoxazole, t etracycline, chloramphenicol and cefotaxime among the isolates of S. pneumo niae. Results: A total of 461 nasal swabs were collected and S, pneumoniae was is olated from 171 (37.1%). Penicillin resistance was found in 12.3% of these isolates, with high level resistance in 0.6%. Resistance rates were higher for cotrimoxazole (44.4%) and erythromycin (18.1%) than for penicillin. Mul tidrug resistance was found in 19% of these isolates. There was a significa nt association between the attendance at a day care centre and carriage of pneumococcus (53% vs 32%, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7, P<0.001). Children who attended day care centres and had received antibiotics during the 4 months prior to swab collection were three times more likely to carry an antibiotic-resistant isolate than children who had neither attended a day care centre nor received antibiotics (68% vs 40%, OR 3.1, 95% CI 1.2-8.4, P=0.02). Conclusion: The level of antibiotic resistance in pneumococci from healthy children was of concern. Carriage of pneumococcus was significantly higher in children who attended a day care centre. Resistance was significantly co rrelated with antibiotic use in combination with day-care attendance. These findings warrant more judicious use of antibiotics in children.