Reduction of antibiotic use in the community reduces the rate of colonization with penicillin G-nonsusceptible Streptococcus pneumoniae

Background. There is a lack of evidence documenting the impact of optimized antibiotic use on the rates of colonization with penicillin G - nonsusceptible Streptococcus pneumoniae ( PNSP) in children. This study evaluates the effect of community-based intervention strategies on the prevalence of PNSP colonization Methods. A controlled, population-based pharmacoepidemiological trial was conducted from January through May 2000. Three French geographic areas were selected on the basis of demographic similarities. Two intervention strategies were implemented: ( 1) reduced antibiotic use, which was achieved by not prescribing antibiotics for presumed viral respiratory tract infections ( the prescription-reduction group); and ( 2) better adaptation of dose and duration ( the dose/duration group). A control group received no intervention. The target population was children aged 3 - 6 years who were attending kindergarten. Oropharyngeal pneumococcus colonization and antibiotic use were monitored throughout the 5-month study. Results. The prescription-reduction, dose/duration, and control groups included 601, 483, and 405 children, respectively. The interventions induced significantly larger decreases in antibiotic use in the prescription- reduction group ( - 18.8%) and dose/duration group ( - 17.1%) than in the control group ( - 3.8%), and the rates of PNSP colonization were initially similar for the 3 groups ( 52.5%, 55.1%, and 50.0%, respectively). At the end of the 5-month study, the rates of PNSP colonization were 34.5% for the prescription- reduction group () and Pp. 05 44.3% for the dose/duration group (P = .05), compared with 46.2% for the control group. Conclusions. Intensive educational strategies aimed at optimizing antibiotic use can significantly reduce the rate of PNSP colonization in areas with high resistance rates.