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Individual-level effects of antibiotics on colonizing otitis pathogens in the nasopharynx

Gisselsson-Solen, Marie LU ; Hermansson, Ann LU and Melhus, Åsa LU (2016) In International Journal of Pediatric Otorhinolaryngology 88. p.17-21
Abstract

Background Although there is evidence of an association between antibiotic consumption and resistant bacteria on a population level, the relationship on an individual level has been less well studied, particularly in terms of nasopharyngeal colonization. We have therefore analysed this association, using data from a closely followed cohort of children taking part in a vaccination trial. Methods 109 children with early onset of acute otitis media (AOM) were randomised to heptavalent pneumococcal conjugate vaccine (PCV7) or no vaccination. They were followed for three years with scheduled appointments as well as sick visits. Nasopharyngeal cultures were obtained at all visits. Antibiotic treatments were recorded, as were risk factors for... (More)

Background Although there is evidence of an association between antibiotic consumption and resistant bacteria on a population level, the relationship on an individual level has been less well studied, particularly in terms of nasopharyngeal colonization. We have therefore analysed this association, using data from a closely followed cohort of children taking part in a vaccination trial. Methods 109 children with early onset of acute otitis media (AOM) were randomised to heptavalent pneumococcal conjugate vaccine (PCV7) or no vaccination. They were followed for three years with scheduled appointments as well as sick visits. Nasopharyngeal cultures were obtained at all visits. Antibiotic treatments were recorded, as were risk factors for AOM, including siblings, short breast-feeding and parental smoking. Data were entered into a Cox regression model, and the findings of Streptococcus pneumoniae and Haemophilus influenzae with reduced susceptibility to the penicillin group were related to the number of previous courses of antibiotics. Results There was evidence of an association between the amount of previously consumed betalactams and colonization with beta-lactamasenegative ampicillin-resistant (BLNAR) H. influenzae (RR 1.21; 95% CI 1.03–1.43; p = 0.03), and also with the most commonly prescribed drug; amoxicillin (RR 1.39; 95% CI 1.09–1.76; p = 0.01). There was no evidence for an association between antibiotic consumption and betalactamase producing H. influenzae or S. pneumoniae with reduced susceptibility to penicillin. Furthermore, there was no evidence of an association between resistant bacteria and AOM risk factors or PCV7. Conclusion In this subgroup of children, most of whom were given several courses of antibiotics in early childhood, there was evidence of an association between betalactam/amoxicillin consumption and nasopharyngeal colonization with BLNAR strains, bacteria that have increased in prevalence during the last 10–15 years, and that are notoriously difficult to treat with oral antibiotics.

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author
organization
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type
Contribution to journal
publication status
published
subject
keywords
Acute otitis media, Antibiotic resistance, BLNAR, Haemophilus influenzae, Nasopharyngeal colonization, Streptococcus pneumoniae
in
International Journal of Pediatric Otorhinolaryngology
volume
88
pages
17 - 21
publisher
Elsevier
external identifiers
  • scopus:84975886710
ISSN
0165-5876
DOI
10.1016/j.ijporl.2016.06.036
language
English
LU publication?
yes
id
09bbe826-8948-4a08-9323-866b1aa6f7ef
date added to LUP
2016-07-18 14:04:53
date last changed
2017-01-18 10:03:48
@article{09bbe826-8948-4a08-9323-866b1aa6f7ef,
  abstract     = {<p>Background Although there is evidence of an association between antibiotic consumption and resistant bacteria on a population level, the relationship on an individual level has been less well studied, particularly in terms of nasopharyngeal colonization. We have therefore analysed this association, using data from a closely followed cohort of children taking part in a vaccination trial. Methods 109 children with early onset of acute otitis media (AOM) were randomised to heptavalent pneumococcal conjugate vaccine (PCV7) or no vaccination. They were followed for three years with scheduled appointments as well as sick visits. Nasopharyngeal cultures were obtained at all visits. Antibiotic treatments were recorded, as were risk factors for AOM, including siblings, short breast-feeding and parental smoking. Data were entered into a Cox regression model, and the findings of Streptococcus pneumoniae and Haemophilus influenzae with reduced susceptibility to the penicillin group were related to the number of previous courses of antibiotics. Results There was evidence of an association between the amount of previously consumed betalactams and colonization with beta-lactamasenegative ampicillin-resistant (BLNAR) H. influenzae (RR 1.21; 95% CI 1.03–1.43; p = 0.03), and also with the most commonly prescribed drug; amoxicillin (RR 1.39; 95% CI 1.09–1.76; p = 0.01). There was no evidence for an association between antibiotic consumption and betalactamase producing H. influenzae or S. pneumoniae with reduced susceptibility to penicillin. Furthermore, there was no evidence of an association between resistant bacteria and AOM risk factors or PCV7. Conclusion In this subgroup of children, most of whom were given several courses of antibiotics in early childhood, there was evidence of an association between betalactam/amoxicillin consumption and nasopharyngeal colonization with BLNAR strains, bacteria that have increased in prevalence during the last 10–15 years, and that are notoriously difficult to treat with oral antibiotics.</p>},
  author       = {Gisselsson-Solen, Marie and Hermansson, Ann and Melhus, Åsa},
  issn         = {0165-5876},
  keyword      = {Acute otitis media,Antibiotic resistance,BLNAR,Haemophilus influenzae,Nasopharyngeal colonization,Streptococcus pneumoniae},
  language     = {eng},
  month        = {09},
  pages        = {17--21},
  publisher    = {Elsevier},
  series       = {International Journal of Pediatric Otorhinolaryngology},
  title        = {Individual-level effects of antibiotics on colonizing otitis pathogens in the nasopharynx},
  url          = {http://dx.doi.org/10.1016/j.ijporl.2016.06.036},
  volume       = {88},
  year         = {2016},
}