2002 Ocular Microbiology and Immunology Group, Abstract 5

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Can Topical Ocular Antibiotics Induce Systemic Resistance?
Bruce Gaynor,¹,² Vicky Cevallos,¹ Yinghui Miao,¹ Elizabeth Yi,¹ Hem Jha,³ Ramesh Bhattta,³
JSP Chaudary,³ John Whitcher,¹,² Susan Osaki-Holm,¹ Alicia Fry,⁴ and Tom Lietman¹,^2
1F.I. Proctor Foundation and the ²Department of Ophthalmology, University of California, San Francisco, ³Geta Eye Hospital, Geta, Nepal, ⁴Respiratory Diseases Branch,
Division of Bacterial and Mycotic Diseases, Centers For Disease Control, Atlanta Georgia

Purpose: A cornerstone of the WHO's program to eliminate blinding trachoma is the use of mass antibiotic administrations. Historically, topical tetracycline has been used for the ocular chlamydia that causes active trachoma; recently, oral azithromycin has been favored due to greater compliance. Here we compare the amount of naso-pharyngeal pneumococcal resistance found after topical tetracycline versus oral azithromycin.

Methods: Two villages in western Nepal were treated as part of the Proctor Foundation
trachoma control program. One village was given 3 annual oral azithromycin distributions
(single dose, 20 mg/kg) and the other village 3 annual topical tetracycline distributions (BID for 6 weeks). All children age 1-10 years old were offered treatment in each village. In May 2001, 6 months after the 3rd treatment in each of the villages, all children 1-7 years were surveyed for Streptococcus pneumoniae carriage and resistance. Nasopharyngeal swabs were performed on each child and transported to the Proctor Foundation laboratory, where pneumococcus was isolated and minimum inhibitory concentration testing was performed.

Results: Streptococcus pneumoniae nasopharyngeal carriage was 122/138 (88%) in the
tetracycline village and 153/183 (84%) in the azithromycin village (p = 0.27). Tetracycline-
resistant pneumococcus isolates were identified in 38/138 (31%) of the swabs from the village treated with tetracycline and 33/183 (22%) from the village treated with azithromycin (p =0.01). Azithromycin-resistant pneumococcus isolates were identified in 0/138 (0%) of the swabs from the village treated with tetracycline and 5/183 (3%) of the swabs from village treated with azithromycin (p = 0.04).

Conclusions: There is a high prevalence of S. pneumoniae in the nasopharynx of
children in Nepal. Mass annual antibiotic administrations of both topical tetracycline and oral
azithromycin can alter the level of drug resistant S. pneumoniae in a community. Contrary to
common wisdom, topical antibiotics can have an effect on systemic bacterial resistance.

Grant & Financial Support: Alta California Foundation, Geta Eye Hospital, Helen Keller
International, Pfizer Inc., National Institute of Allergy & Infectious Diseases (K08 AI 01441)

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