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Impact of recent antibiotics on nasopharyngeal carriage and lower airway infection in Indigenous Australian children with non-cystic fibrosis bronchiectasis

Hare, Kim M., Leach, Amanda J., Morris, Peter S., Smith-Vaughan, Heidi C., Torzillo, Paul J., Bauert, Paul, Cheng, Allen C., McDonald, Malcolm I., Brown, N., Chang, Anne B. and Grimwood, Keith (2012). Impact of recent antibiotics on nasopharyngeal carriage and lower airway infection in Indigenous Australian children with non-cystic fibrosis bronchiectasis. International Journal of Antimicrobial Agents,40(4):365-369.

Document type: Journal Article
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IRMA ID cmartelxPUB34
Title Impact of recent antibiotics on nasopharyngeal carriage and lower airway infection in Indigenous Australian children with non-cystic fibrosis bronchiectasis
Author Hare, Kim M.
Leach, Amanda J.
Morris, Peter S.
Smith-Vaughan, Heidi C.
Torzillo, Paul J.
Bauert, Paul
Cheng, Allen C.
McDonald, Malcolm I.
Brown, N.
Chang, Anne B.
Grimwood, Keith
Journal Name International Journal of Antimicrobial Agents
Publication Date 2012
Volume Number 40
Issue Number 4
ISSN 0924-8579   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84866027983
Start Page 365
End Page 369
Total Pages 5
Place of Publication Netherlands
Publisher Elsevier BV
HERDC Category C1 - Journal Article (DIISR)
Abstract Indigenous Australian children have increased rates of bronchiectasis. Despite a lack of high-level evidence on effectiveness and antibiotic resistance, these children often receive long-term antibiotics. In this study, we determined the impact of recent macrolide (primarily azithromycin) and β-lactam antibiotic use on nasopharyngeal colonisation, lower airway infection (>104CFU/mL of bronchoalveolar lavage fluid culture) and antibiotic resistance in non-typeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae and Moraxella catarrhalis isolates from 104 Indigenous children with radiographically confirmed bronchiectasis. Recent antibiotic use was associated with significantly reduced nasopharyngeal carriage, especially of S. pneumoniae in 39 children who received macrolides [odds ratio (OR)=0.22, 95% confidence interval (CI) 0.08–0.63] and 26 children who received β-lactams (OR=0.07, 95% CI 0.01–0.32), but had no significant effect on lower airway infection involving any of the three pathogens. Children given macrolides were significantly more likely to carry (OR=4.58, 95% CI 1.14–21.7) and be infected by (OR=8.13, 95% CI 1.47–81.3) azithromycin-resistant S. pneumoniae. Children who received β-lactam antibiotics may be more likely to have lower airway infection with β-lactamase-positive ampicillin-resistant NTHi (OR=4.40, 95% CI 0.85–23.9). The risk of lower airway infection by antibiotic-resistant pathogens in children receiving antibiotics is of concern. Clinical trials to determine the overall benefit of long-term antibiotic therapy are underway.

Keywords Azithromycin
Bronchiectasis
Microbial drug restistance
Nasopharynx
Respiratory tract infections
DOI http://dx.doi.org/10.1016/j.ijantimicag.2012.05.018   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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