%0 Journal Article %1 gill_effect_2008 %A Gill, C J %A Mwanakasale, V %A Fox, M P %A Chilengi, R %A Tembo, M %A Nsofwa, M %A Chalwe, V %A Mwananyanda, L %A Mukwamataba, D %A Malilwe, B %A Champo, D %A Macleod, W B %A Thea, D M %A Hamer, D H %D 2008 %J Bulletin of the World Health Organization %K imported %N 12 %P 929--38 %T Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants: a longitudinal cohort study %U http://www.ncbi.nlm.nih.gov/pubmed/19142293 %V 86 %X OBJECTIVE: To ascertain the microbiological consequences of WHO's recommendation for presumptive co-trimoxazole prophylaxis for infants with perinatal HIV exposure. METHODS: Using a longitudinal cohort design, we followed HIV-exposed and HIV-unexposed infants trimonthly for up to 18 months per infant. HIV-exposed infants received daily co-trimoxazole prophylaxis from 6 weeks to \textgreater or = 12 months of age. Using Streptococcus pneumoniae as our sentinel pathogen, we measured how co-trimoxazole altered nasopharyngeal colonization, pneumococcal resistance to antibiotics and serotype distribution as a function of co-trimoxazole exposure. FINDINGS: From 260 infants followed for 3096 patient-months, we detected pneumococci in 360/1394 (25.8\%) samples. HIV-exposed infants were colonized more frequently than HIV-unexposed infants (risk ratio, RR: 1.4; 95\% confidence interval, CI: 1.0-1.9, P = 0.04). Co-trimoxazole prophylaxis reduced colonization by ca 7\% but increased the risk of colonization with co-trimoxazole-resistant pneumococci within 6 weeks of starting prophylaxis (RR: 3.2; 95\% CI: 1.3-7.8, P = 0.04). Prophylaxis with co-trimoxazole led to a small but statistically significant increase of nasopharyngeal colonization with pneumococci not susceptible to clindamycin (RR: 1.6; 95\% CI: 1.0-2.6, P = 0.04) but did not increase the risk of non-susceptibility to penicillin (RR: 1.1; 95\% CI: 0.7-1.7), erythromycin (RR: 1.0; 95\% CI: 0.6-1.7), tetracycline (RR: 0.9; 95\% CI: 0.6-1.5) or chloramphenicol (RR: 0.8; 95\% CI: 0.3-2.3). Co-trimoxazole prophylaxis did not cause the prevailing pneumococcal serotypes to differ from those that are targeted by the 7-valent conjugate pneumococcal vaccine (RR: 1.0; 95\% CI: 0.7-1.6). CONCLUSION: Co-trimoxazole prophylaxis modestly suppresses pneumococcal colonization but accelerates infant acquisition of co-trimoxazole- and clindamycin-resistant pneumococci. Co-trimoxazole prophylaxis appears unlikely to compromise the future efficacy of conjugate vaccines.

@article{gill_effect_2008, abstract = {{OBJECTIVE:} To ascertain the microbiological consequences of {WHO's} recommendation for presumptive co-trimoxazole prophylaxis for infants with perinatal {HIV} exposure. {METHODS:} Using a longitudinal cohort design, we followed {HIV-exposed} and {HIV-unexposed} infants trimonthly for up to 18 months per infant. {HIV-exposed} infants received daily co-trimoxazole prophylaxis from 6 weeks to {\textgreater} or = 12 months of age. Using Streptococcus pneumoniae as our sentinel pathogen, we measured how co-trimoxazole altered nasopharyngeal colonization, pneumococcal resistance to antibiotics and serotype distribution as a function of co-trimoxazole exposure. {FINDINGS:} From 260 infants followed for 3096 patient-months, we detected pneumococci in 360/1394 (25.8\%) samples. {HIV-exposed} infants were colonized more frequently than {HIV-unexposed} infants (risk ratio, {RR:} 1.4; 95\% confidence interval, {CI:} 1.0-1.9, P = 0.04). Co-trimoxazole prophylaxis reduced colonization by ca 7\% but increased the risk of colonization with co-trimoxazole-resistant pneumococci within 6 weeks of starting prophylaxis {(RR:} 3.2; 95\% {CI:} 1.3-7.8, P = 0.04). Prophylaxis with co-trimoxazole led to a small but statistically significant increase of nasopharyngeal colonization with pneumococci not susceptible to clindamycin {(RR:} 1.6; 95\% {CI:} 1.0-2.6, P = 0.04) but did not increase the risk of non-susceptibility to penicillin {(RR:} 1.1; 95\% {CI:} 0.7-1.7), erythromycin {(RR:} 1.0; 95\% {CI:} 0.6-1.7), tetracycline {(RR:} 0.9; 95\% {CI:} 0.6-1.5) or chloramphenicol {(RR:} 0.8; 95\% {CI:} 0.3-2.3). Co-trimoxazole prophylaxis did not cause the prevailing pneumococcal serotypes to differ from those that are targeted by the 7-valent conjugate pneumococcal vaccine {(RR:} 1.0; 95\% {CI:} 0.7-1.6). {CONCLUSION:} Co-trimoxazole prophylaxis modestly suppresses pneumococcal colonization but accelerates infant acquisition of co-trimoxazole- and clindamycin-resistant pneumococci. Co-trimoxazole prophylaxis appears unlikely to compromise the future efficacy of conjugate vaccines.}, added-at = {2011-03-11T10:05:34.000+0100}, author = {Gill, C J and Mwanakasale, V and Fox, M P and Chilengi, R and Tembo, M and Nsofwa, M and Chalwe, V and Mwananyanda, L and Mukwamataba, D and Malilwe, B and Champo, D and Macleod, W B and Thea, D M and Hamer, D H}, biburl = {https://www.bibsonomy.org/bibtex/2745afc734fd409f7cab43c8846a6bd96/jelias}, interhash = {01c7837fdb9da8614ff35a8149eb6a11}, intrahash = {745afc734fd409f7cab43c8846a6bd96}, issn = {0042-9686}, journal = {Bulletin of the World Health Organization}, keywords = {imported}, month = dec, note = {{PMID:} 19142293}, number = 12, pages = {929--38}, shorttitle = {Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants}, timestamp = {2011-03-11T10:06:30.000+0100}, title = {Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants: a longitudinal cohort study}, url = {http://www.ncbi.nlm.nih.gov/pubmed/19142293}, volume = 86, year = 2008 }