Antibiotic resistance among respiratory pathogens in preschool children

Abstract

Objective: To determine the prevalence of antibiotic resistance among common respiratory pathogens circulating in the community.

Design: Survey of common respiratory pathogens isolated from nasal discharges.

Setting: 117 childcare centres and kindergartens in metropolitan Melbourne between May and July 1991-1993 and 42 from sociodemographically matching suburbs in Sydney between May and July, 1993.

Subjects: Children aged six years and under with nasal discharge.

Outcome measures: Resistance to penicillins, erythromycin and tetracycline among isolates of Haemophilus influenzae, Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis and Staphylococcus aureus.

Results: A total of 2286 nasal discharge swabs were collected. Amoxycillin resistance was detected in 99 of 711 isolates of H. influenzae (13.9%) and penicillin resistance in 781 of 834 isolates of M. catarrhalis (93.6%), 342 of 375 isolates of S. aureus (91.2%), and 30 of 781 isolates of S. pneumoniae (3.9%). Of 86 strains of H. influenzae type b isolated, 20 (23.3%) produced beta-lactamase. Penicillin resistance tended to become more common among isolates of H. influenzae and S. pneumoniae during the three-year period.

Conclusion: Antibiotic resistance, mediated by beta-lactamase or altered penicillin-binding proteins, among respiratory pathogens carried by preschool children was significant and possibly increasing. This highlights the impact of prescribed antibiotics in the community and the folly of prescribing the limited store of antibiotics for viral infections.