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O088 - THE IMPACT OF THE ADDITION OF AZITHROMYCIN TO THE ANTIMALARIALS USED FOR SEASONAL MALARIA CHEMOPREVENTION ON ANTIMICROBIAL RESISTANCE OF STREPTOCOCCUS PNEUMONIAE (ID 297)
Abstract
Background
A trial has been conducted in children in Burkina Faso and Mali to investigate whether addition of azithromycin (AZ) to the antimalarials used for seasonal malaria chemoprevention reduces child mortality and hospital admissions. We report the sensitivity of nasal isolates of Streptococcus pneumoniae to AZ and other antibiotics obtained during the course of the trial.
Methods
AZ or placebo was administered monthly, in combination with the antimalarials sulphadoxine-pyrimethamine and amodiaquine, for four months over the annual malaria transmission seasons of 2014, 2015 and 2016. Nasopharyngeal swabs were collected from 2773 Burkinabe children and 2709 Malian children during seven surveys. Pneumococci were isolated and tested for sensitivity to AZ and other antibiotics.
Results
A total of 5482 nasopharyngeal samples were collected over 3 years. In Burkina Faso, the prevalence of overall carriage of Streptococcus pneumoniae decreased from 67.4% (290/430) in 2014 to 46.7% (185/396) in 2016. The proportion of AZ-resistant pneumococci in children who had received AZ increased from 4.9% (7/143) to 25.6% (22/86). In Mali, overall carriage increased from 63% (217/342) in 2014 to 40.5% (155/385) in 2016 with the proportion of AZ resistance of AZ resistance increasing from 7.6 (8/106) to 68.5% (37/54). Resistance remained high in Burkina Faso 17.7% (17/96) and Mali 19.1% (29/152) in the group of children who received AZ one year after the intervention was stopped.
Conclusions
Addition of AZ to the antimalarial combination was associated with an increase in resistance of pneumococci to AZ, which persisted for one year after the last administration of AZ.