Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo
Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote re...
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Veröffentlicht in: | European journal of clinical microbiology & infectious diseases 2015-11, Vol.34 (11), p.2275-2285 |
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Sprache: | eng |
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Zusammenfassung: | Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote regions and urban New Zealand Māori and Pacific Islander children with bronchiectasis were randomized to weekly azithromycin (30 mg/kg) or placebo for up to 24 months and followed post-intervention for up to 12 months. Nurses administered and recorded medications given and collected nasopharyngeal swabs 3–6 monthly for culture and antimicrobial susceptibility testing. Nasopharyngeal carriage of
Haemophilus influenzae
and
Moraxella catarrhalis
was significantly lower in azithromycin compared to placebo groups, while macrolide-resistant
Streptococcus pneumoniae
and
Staphylococcus aureus
carriage was significantly higher. Australian children, compared to New Zealand children, had higher carriage overall, significantly higher carriage of macrolide-resistant bacteria at baseline (16/38 versus 2/40 children) and during the intervention (69/152 versus 22/239 swabs), and lower mean adherence to study medication (63 % versus 92 %). Adherence ≥70 % (versus |
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ISSN: | 0934-9723 1435-4373 |
DOI: | 10.1007/s10096-015-2480-0 |