Abstract
Oral azithromycin given to women in labor decreases maternal and neonatal bacterial carriage but increases azithromycin-resistant bacteria during at least 4 weeks following the intervention. We assessed the prevalence of bacterial carriage and azithromycin resistance 12 months after treatment among study infants. Nasopharyngeal swabs (NPSs) were collected between November 2014 and May 2015 from children aged 11-13 months whose mothers had received azithromycin or placebo during labor. Streptococcus pneumoniae and Staphylococcus aureus were isolated using conventional microbiological methods. Antibiotic susceptibility was determined by disk diffusion and confirmed by Etest or VITEK-2. NPSs were collected from 461 children. The prevalence of S. pneumoniae and S. aureus was similar between children from the azithromycin and placebo arms (85.0% vs 82.1%; odds ratio [OR], 1.23 [95% confidence interval {CI}, .73-2.08] for S. pneumoniae and 21.7% vs 21.3%; OR, 1.02 [95% CI, .64-1.64] for S. aureus). Prevalence of azithromycin-resistant S. pneumoniae was similar in both arms (1.8% vs 0.9% in children from the azithromycin and placebo arms, respectively; OR, 2.10 [95% CI, .30-23.38]); resistance to other antibiotics was also similar between arms. For S. aureus, there was no difference in azithromycin resistance between children in the azithromycin (3.1%) and placebo (2.6%) arms (OR, 1.22 [95% CI, .35-4.47]) or resistance to any other antibiotics. The higher prevalence of S. aureus azithromycin resistance observed among women treated during labor and their babies 4 weeks after treatment had waned 12 months after delivery. Azithromycin intervention did not induce other antibiotic resistance to S. pneumoniae or S. aureus. NCT01800942.
Highlights
Oral azithromycin given to women in labor decreases maternal and neonatal bacterial carriage but increases azithromycin-resistant bacteria during at least 4 weeks following the intervention
The prevalence of S. pneumoniae and S. aureus was similar between children from the azithromycin and placebo arms (85.0% vs 82.1%; odds ratio [OR], 1.23 [95% confidence interval {CI}, .73–2.08] for S. pneumoniae and 21.7% vs 21.3%; OR, 1.02 [95% CI, .64–1.64] for S. aureus)
Prevalence of azithromycin-resistant S. pneumoniae was similar in both arms (1.8% vs 0.9% in children from the azithromycin and placebo arms, respectively; OR, 2.10 [95% CI, .30–23.38]); resistance to other antibiotics was similar between arms
Summary
Nasopharyngeal swabs (NPSs) were collected between November 2014 and May 2015 from children aged 11–13 months whose mothers had received azithromycin or placebo during labor. Details of the study protocol have been described elsewhere [21] This was a phase 3, double-blind, placebo-controlled trial where 829 pregnant women attending the labor ward in the study health facility were randomized to receive a single oral dose of 2 g of either oral azithromycin or placebo (ratio 1:1). Prevalence of nasopharyngeal carriage of S. pneumoniae was significantly lower during the entire neonatal period among neonates exposed to azithromycin (at day 28: 37.2% vs 24.8%; prevalence ratio [PR], 0.67 [95% confidence interval {CI}, .53–.83]; P < .001). Streptococcus pneumoniae After 20–24 hours of incubation at 37°C with 5% carbon dioxide, GBA plates were examined for typical α-hemolytic colonies. 1192 CID 2018:67 (15 October) Bojang et al Staphylococcus aureus Following 48 hours of incubation at 37°C, MSA plates were examined for typical staphylococci colonies. Isolates testing positive for coagulase were confirmed to be S. aureus
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