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Topical ocular antibiotics induce bacterial resistance at extraocular sites

¹ The F I Proctor Foundation, University of California, San Francisco, CA, USA
² Department of Ophthalmology, University of California, San Francisco, CA, USA
³ Institute for Global Health, University of California, San Francisco, CA, USA
⁴ Geta Eye Hospital, Geta, Nepal
⁵ Department of Public Health, San Francisco, CA, USA
⁶ Respiratory Diseases Branch, Centers for Disease Control, Atlanta, GA, USA

Correspondence to:
Correspondence to:
Associate Professor T M Lietman
Director of the WHO Collaborating Center for the Prevention of Blindness, Department of Ophthalmology, F I Proctor Foundation, 95 Kirkham Street, Room 307, University of California San Francisco, San Francisco, CA 94143-0944, USA; TML{at}itsa.ucsf.edu

ABSTRACT
Aim: To compare the prevalence of antibiotic resistance found in nasopharyngeal Streptococcus pneumoniae between villages treated with topical tetracycline or systemic azithromycin as part of a trachoma control programme.

Methods: All children aged 1–10 years were offered either single dose oral azithromycin treatment (20 mg/kg) or a course of topical 1% tetracycline ointment, depending on the area. Treatment was given annually for 3 years. Six months after the third annual treatment in each village, children were surveyed for nasopharyngeal carriage of S pneumoniae and resistance was determined using broth dilution MIC technique. Children in two additional villages, which had not yet been treated, were also surveyed.

Results: Nasopharyngeal carriage of S pneumoniae was similar in the tetracycline treated, azithromycin treated, and untreated areas (p = 0.57). However, resistance to tetracycline and azithromycin was distributed differently between the three areas (p = 0.004). The village treated with topical tetracycline had a higher prevalence of tetracycline resistance than the other villages (p = 0.010), while the oral azithromycin treated village had a higher prevalence of macrolide resistance than the other villages (p = 0.014).

Conclusions: Annual mass treatment with oral azithromycin may alter the prevalence of drug resistant S pneumoniae in a community. Surprisingly, topical tetracycline may also increase nasopharyngeal pneumococcal resistance. Topical antibiotics may have an effect on extraocular bacterial resistance.

Abbreviations: NCCLS, National Committee for Clinical Laboratory Standards

Keywords: azithromycin; pneumococcus; resistance; trachoma; tetracycline

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