Prevalence of nasopharyngeal antibiotic-resistant pneumococcal carriage inchildren attending private paediatric practices in Johannesburg

Objectives. To determine the nasopharyngeal carriage rate, serogroups/types , and antibiotic resistance of Streptococcus pneumoniae in children attendi ng paediatric practices in the private sector in Johannesburg and to relate patterns of resistance to antimicrobial exposure and other demographic cha racteristics in individual children. Design. A total of 303 children aged from 1 month to 5 years were recruited from eight private paediatric practices in northern Johannesburg. Nasophar yngeal samples were taken and parent interviews were conducted. Results. Pneumococci were isolated from 121 children (40%). The most common serotypes were 6B, 19F, 6A, 23F, 14, and 19A. Carriage was significantly a ssociated with prior hospital admission (odds ratio 1.89) and day fare atte ndance (odds ratio 2.31) and was negatively associated with antibiotic use within the previous 30 days. Antibiotic resistance was found in 84 isolates (69.4%); 45 (37.2%) were multiply resistant. One-third of the pneumococci showed intermediate level resistance to penicillin and 12.4% were highly re sistant. There was a high level erythromycin resistance in 38% of the isola tes. A total of 94/214 children (42%) had recently used antibiotics and wer e four times more likely to carry antibiotic-resistant pneumococci (P < 0.0 5). Conclusion. Pneumococcal resistance was significant in this group of childr en with easy access to paediatric services and antibiotic use. The implicat ion of such high resistance for the treatment of pneumococcal diseases is t hat high-dose amoxicillin is the preferred empirical oral therapy for treat ment of otitis media. Ceftriaxone or cefotaxime should be used in combinati on with vancomycin for the treatment of meningitis until a cephalosporin-re sistant pneumococcal cause is excluded. Intravenous penicillin or ampicilli n will successfully treat pneumococcal pneumonia in this population. Antimi crobial resistance among pneumococci colonising children in the private sec tor has increased dramatically in recent years.