Resistance of Nasopharyngeal Pathogens and Antimicrobial Prescription Rates for Children in an Area Under Controlled Antimicrobial Use

Abstract

To reduce the spread of drug-resistant pathogens, appropriate use of antimicrobials is an indispensable measure. From January 2002, we undertook campaigns about antimicrobial treatment in Sado Island, Japan. The subjects were born in 1996 (group-1996) or during 2002-2004 (group-2002-2004) and received outpatient treatment at our hospital. We evaluated the subjects' medical information from patient records during their first 3 years of life. Demographic data, duration of breast-feeding, and attending a day-care center (DCC) were evaluated using a questionnaire. Average visit-based antimicrobial prescription rates significantly decreased from 535 for group-1996, to 70 for group-2002-2004 per 1000 hospital visits (P < 0.001). The rate of cephalosporin prescriptions significantly decreased (77.1%-16.7%; P < 0.001), while amoxicillin (0.8%-29.5%) and macrolides (21.0%-52.4%) significantly increased (P < 0.001). Regarding 417 nasopharyngeal cultures from group-2002-2004, 77.8% (179/230) of Streptococcus pneumoniae strains were nonsusceptible to penicillin. For Haemophilus influenzae strains, 30.6% (59/193) were nonsusceptible to ampicillin. Living with older sibling(s) and early DCC attendance were associated with carriage of resistant pathogens. In a closed area under controlled antimicrobial use, our data indicated that decreasing antimicrobial prescriptions alone could not achieve elimination of resistant pathogens. Strategies to control transmission at DCCs or from older sibling(s) are also essential.