Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo

Kim Maree Hare, Keith Grimwood, Anne Bernadette Chang, Mark D Chatfield, Patricia C Valery, Amanda Jane Leach, Heidi Smith-Vaughan, Peter S Morris, Catherine A Byrnes, Paul J Torzillo, Allen Cheuk-Seng Cheng

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34 Citations (Scopus)

Abstract

Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote regions and urban New Zealand Maori and Pacific Islander children with bronchiectasis were randomized to weekly azithromycin (30 mg/kg) or placebo for up to 24 months and followed post-intervention for up to 12 months. Nurses administered and recorded medications given and collected nasopharyngeal swabs 3-6 monthly for culture and antimicrobial susceptibility testing. Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups, while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher. Australian children, compared to New Zealand children, had higher carriage overall, significantly higher carriage of macrolide-resistant bacteria at baseline (16/38 versus 2/40 children) and during the intervention (69/152 versus 22/239 swabs), and lower mean adherence to study medication (63 versus 92 ). Adherence =70 (versus
Original languageEnglish
Pages (from-to)2275 - 2285
Number of pages11
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume34
Issue number11
DOIs
Publication statusPublished - 2015

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