Frequency of penicillin-resistant pneumococci in children is correlated tocommunity utilization of antibiotics

Objective. To study the impact of the utilization of antibiotics in childre n at the population level on the frequency of penicillin-nonsusceptible pne umococci (PNSP), Design. Children ages 0 to 6 years with a nasopharyngeal culture of PNSP we re registered on place of residency in the 20 municipalities of the former Malmohus County (since 1998 a part of Skane County). Where possible the tot al number of nasopharyngeal cultures with growth of pneumococci was registe red as well. All antibiotic prescriptions for 0- to 6-year-old children wer e analyzed in the 20 municipalities. Main outcome measures. Correlation between the utilization of antibiotics a nd the frequency of PNSP in children at the municipality level, Results. The proportion of PNSP among all isolates of pneumococci from naso pharyngeal cultures varied between 0 and 49.5%. The antibiotic utilization in children varied among the 20 neighboring municipalities from 8.5 to 19.7 defined daily doses per 1000 children per day. The municipalities with hig h total utilization also had more frequent use of macrolides and broad spec trum antibiotics. The was a significant correlation between antibiotic use and the proportion of PNSP (correlation coefficient, 0.96; P = 0,002), and the correlation coefficients for trimethoprim-sulfamethoxazole, amoxicillin s, macrolides and cephalosporins were significant at the 0,001 level. There was no significant correlation between the use of penicillin V and the fre quency of PNSP, Conclusions. There was a significant correlation between the frequency of P NSP and the utilization of antibiotics in children at the population level.