A Cross-Sectional Study of the Availability of Azithromycin in Local Pharmacies and Associated Antibiotic Resistance in Communities in Kilosa District, Tanzania

Derick Ansah Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland;

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Jerusha Weaver Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland;

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Beatriz Munoz Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland;

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Evan M. Bloch Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland;

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Christian L. Coles Uniformed Services University of Health Sciences, Bethesda, Maryland;

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Thomas Lietman Proctor Foundation, University of California San Francisco, San Francisco, California

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Sheila K. West Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland;

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Mass drug administration (MDA) for trachoma control using azithromycin has generated concern for the development of resistant organisms. However, the contribution from azithromycin available in local pharmacies has not been studied. In Kilosa district, Tanzania, MDA stopped over 4 years ago, and this study sought to determine the availability of azithromycin in local pharmacies and correlate it with azithromycin resistance in children born after MDA. A cross-sectional survey was conducted in 644 randomly selected hamlets in Kilosa district, in which the presence of a pharmacy and the availability of azithromycin and erythromycin were determined. In 30 randomly selected hamlets, a random sample of 60 children less than 5 years were tested for azithromycin-resistant Streptococcus pneumoniae (Spn) and Escherichia coli (Ec), from nasopharyngeal and rectal swabs, based on disk diffusion criteria. Only 26.6% of hamlets had a pharmacy. Azithromycin and erythromycin were available in 30.8% and 89.1% of pharmacies closest to the hamlets, respectively. In the 30 communities tested for resistance, the overall prevalence of azithromycin-resistant Spn isolates was 14%. Six of seven (87%) hamlets where azithromycin was available had resistant Spn, compared with 14 of 23 (61%) hamlets without availability. Similarly, six of seven (87%) hamlets where azithromycin was available had resistant Ec isolates compared with 21 of 23 (70%) hamlets without availability. However, the differences were not statistically significant (P = 0.46 and 0.49, respectively). The availability of azithromycin in pharmacies in the district was limited, and a strong correlation with azithromycin-resistant Spn or Ec was not observed.

Author Notes

Address correspondence to Sheila West, Wilmer Eye Institute, Johns Hopkins Hospital, Wilmer Rm. 129, 600 N Wolfe St., Baltimore, MD 21205. E-mail: shwest@jhmi.edu

Financial support: Grant from the Bill & Melinda Gates Foundation. D. A.’s travel was supported by a grant from the Dean of Student Affairs’ office at the Johns Hopkins School of Medicine.

Authors’ addresses: Derick Ansah, Jerusha Weaver, Beatriz Munoz, and Sheila K. West, Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, E-mails: dansah1@jhmi.edu, jerusha.u.weaver@gmail.com, bmunoz@jhmi.edu, and shwest@jhmi.edu. Evan M. Bloch, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, E-mail: ebloch2@jhmi.edu. Christian L. Coles, Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, MD, E-mail: ccoles1@jhu.edu. Thomas Lietman, Proctor Foundation, University of California San Francisco, San Francisco, CA, E-mail: tom.lietman@ucsf.edu.

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