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Antibiotic Resistance in Young Children in Kilosa District, Tanzania 4 Years after Mass Distribution of Azithromycin for Trachoma Control

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

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

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Kasubi MabulaDepartment of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;

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

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Zakayo MrangoNational Institute for Medical Research, Kilosa, Tanzania;

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

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Thomas LietmanFrancis I Proctor Foundation, University of California San Francisco, San Francisco, California;

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Christian ColesInfectious Disease Clinical Research Program, Uniformed University of the Health Sciences, Bethesda, Maryland

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Mass administration of azithromycin (MDA) is integral to trachoma control. Recent studies suggest that MDA may increase drug-resistant pathogens, yet findings from prior studies suggest little long-term impact on resistance. This disparity may be linked to differences in pre-MDA community-level resistance patterns. We describe carriage prevalence and antibiotic resistance patterns for Streptococcus pneumoniae (Spn) (nasopharyngeal swab collection), Staphylococcus aureus (SA) (nasopharyngeal swabs), and Escherichia coli (EC) (rectal swabs) in 1,047 children ages 1–59 months in a district with MDA cessation 4 years ago. Antibiotic susceptibility was evaluated by disk diffusion and Etest. The carriage rates for Spn, SA, and EC were 43.5% (455/1,047), 13.2% (138/1,047), and 61.7% (646/1,047), respectively. Resistance to AZM was observed in 14.3%, 29.0%, and 16.6% of the Spn, SA, and EC isolates, respectively. Spn resistance was variable (0–67%) by hamlet. Future analyses will assess the influence of pre-MDA antibiotic resistance patterns on those observed following MDA.

Author Notes

Address correspondence to Evan M. Bloch, Department of Pathology, Johns Hopkins School of Medicine, 600 North Wolfe Street/Carnegie, Baltimore, MD 21287-2182. E-mail: ebloch2@jhmi.edu

Financial support: This study was made possible by a grant from the Bill & Melinda Gates Foundation (OPP1032340).

Authors’ addresses: Evan M. Bloch, Department of pathology, Johns Hopkins Medicine, Baltimore, MD, E-mail: ebloch2@jhmi.edu. Sheila K. West, Jerusha Weaver, and Beatriz Munoz, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, E-mails: shwest@jhmi.edu, jerusha.u.weaver@gmail.com, and bmunoz@jhmi.edu. Kasubi Mabula, Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, E-mail: mkasubi68@gmail.com. Zakayo Mrango, National Institute for Medical Research, Kilosa, Tanzania, E-mail: mrango@yahoo.com. Thomas Lietman, Proctor Foundation, University of California San Francisco, San Francisco, CA, E-mail: tom.lietman@ucsf.edu. Christian Coles, Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mail: ccoles@idcrp.org.

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