Epidemiology| October 01 2001 Short-Course, High-Dose Amoxicillin: Effect on Pneumococcal Carriage AAP Grand Rounds (2001) 6 (4): 43–44. https://doi.org/10.1542/gr.6-4-43 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Short-Course, High-Dose Amoxicillin: Effect on Pneumococcal Carriage. AAP Grand Rounds October 2001; 6 (4): 43–44. https://doi.org/10.1542/gr.6-4-43 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: amoxicillin, disease transmission Source: Schrag SJ, Peña C, Fernández J, et al. Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomized trial. JAMA. 2001;286:49–56. These investigators in the Dominican Republic sought to determine whether short-course, high-dose amoxicillin therapy reduces the risk of posttreatment penicillin-nonsusceptible pneumococcal carriage among children with respiratory tract infections. ( The term “nonsusceptible” includes both resistant and intermediate susceptibility to penicillin.) They conducted a randomized trial in an outpatient clinic in Santo Domingo from October 1999–July 2000. Children from 6–59 months who were receiving antibiotics for a respiratory tract infection (n=795) were randomly assigned to receive amoxicillin twice daily, either 90 mg/kg/day for 5 days or 40 mg/kg/day for 10 days. At the onset of the study, patients had similar baseline characteristics, with 27% and 26% of the patients in the short-course, high-dose and standard-course groups, respectively, carrying penicillin-nonsusceptible strains. Less than 1% of all isolates were nonsusceptible to amoxicillin. At the day 28 visit, the prevalence of penicillin-nonsusceptible pneumococci was significantly higher in the standard course group (32%) compared with the short-course, high-dose group (24%), with a relative risk of 1.3 (95% CI, 1.03–1.7). The protective effect of the short-course, high-dose regimen was stronger in homes with 3 or more children. Adherence to treatment (determined by volume of amoxicillin remaining) was also higher in the short-course, high-dose group (82% versus 74%, P=.02). There were no differences in adverse events in the 2 groups, eg, diarrhea, vomiting, rash. Streptococcus pneumoniae kills approximately 1 million children under age 5 per year.1 The spread of drug-resistant pneumococci has major public health implications for children and adults.2 Shorter courses of antibiotics may reduce patient and community exposure to resistant strains of pneumococci, and may improve patient adherence with drug regimens. Higher doses of antibiotics may inhibit drug-resistant strains.3 Most previous studies of short-term, high-dose antibiotics have focused on clinical outcomes rather than carriage of drug-resistant strains. Here, Schrag et al demonstrate the effectiveness of short-term, high-dose amoxicillin in young children with respiratory tract illnesses in reducing carriage of penicillin-resistant pneumococci. Not surprisingly, adherence was increased in this group. They make no attempt to verify the diagnoses or follow the clinical course of disease and, consequently, do not make any claims regarding comparative clinical efficacy of the 2 regimens. The authors also note that penicillin nonsusceptibility correlates with genetically unrelated resistance profiles so that intervention to reduce the risk of penicillin-nonsusceptible pneumococcus may also reduce the risk of carrying strains that are relatively resistant to other classes of drugs.4 Campaigns for appropriate and decreased antibiotic use, along with the conjugate pneumococcal vaccine, are important strategies in reducing antibiotic-resistant bacteria. If the results of Schrag et al are confirmed in other populations, pediatricians will have another tool to reduce the prevalence of drug-resistant pneumococci, with the added benefit of low cost and better compliance. Overuse of antibiotics—be it in cattle feed or human medications—is the major reason for microbial resistance to them.... You do not currently have access to this content.