Topical ocular antibiotics induce bacterial resistance at extraocular sites

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.