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Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study

BMJ 1996; 313 doi: (Published 17 August 1996) Cite this as: BMJ 1996;313:387
  1. Vilhjalmur A Arason, general practitionera,
  2. Karl G Kristinsson, associate professorb,
  3. Johann A Sigurdsson, professora,
  4. Gudrun Stefansdottir, chief medical laboratory scientific officerc,
  5. Sigvard Molstad, general practitionerd,
  6. Sigurdur Gudmundsson, associate professore
  1. a Department of Family Medicine, Solvangur Health Centre, University of Iceland, IS-220 Hafnarfjordur, Iceland
  2. b Department of Microbiology, Landspitalinn (University Hospital), IS-101 Reykjavik, Iceland
  3. c Microbiology Laboratory, Borgarspitalinn (Reykjavik City Hospital), IS-108 Reykjavik, Iceland
  4. d Hoor Health Centre, S-243 30 Hoor, Sweden
  5. e Department of Internal Medicine, Landspitalinn, IS-101 Reykjavik
  1. Correspondence to: Dr Arason.
  • Accepted 17 June 1996


Objective: To study the correlation of antimicrobial consumption with the carriage rate of penicillin resistant and multiresistant pneumococci in children.

Design: Cross sectional and analytical prevalence study.

Setting: Five different communities in Iceland.

Main outcome measure: Prevalence of nasopharyngeal carriage of penicillin resistant pneumococci in children aged under 7 years in relation to antibiotic use as determined by information from parents, patient's records, and total sales of antimicrobials from local pharmacies in four study areas.

Results: Total antimicrobial sales for children (6223 prescriptions) among the four areas for which data were available ranged from 9.6 to 23.2 defined daily doses per 1000 children daily (1.1 to 2.6 courses yearly per child). Children under 2 consumed twice as much as 2-6 year olds (20.5 v 10.9 defined daily doses per 1000 children daily). Nasopharyngeal specimens were obtained from 919 children, representing 15-38% of the peer population groups in the different areas. Pneumococci were carried by 484 (52.7%) of the children, 47 (9.7%) of the isolates being resistant to penicillin or multiresistant. By multivariate analysis age (<2 years), area (highest antimicrobial consumption), and individual use of antimicrobials significantly influenced the odds of carrying penicillin resistant pneumococci. By univariate analysis, recent antimicrobial use (two to seven weeks) and use of co-trimoxazole were also significantly associated with carriage of penicillin resistant pneumococci.

Conclusions: Antimicrobial use, with regard to both individual use and total antimicrobial consumption in the community, is strongly associated with nasopharyngeal carriage of penicillin resistant pneumococci in children. Control measures to reduce the prevalence of penicillin resistant pneumococci should include reducing the use of antimicrobials in community health care.

Key messages

  • Study of the carriage of penicillin resistant pneumococci in 919 children in five different com- munities clearly showed the association of anti- microbial use with the level of resistance

  • Repeated antimicrobial treatment courses and selective antimicrobial pressure may be particular risks for carrying resistant pneumococci

  • Reducing the usage of antimicrobials, especially in children, is likely to be effective in preventing or reducing the spread of penicillin resistant and multiresistant pneumococci


  • Funding Research fund of the Icelandic College of Family Physicians and the University of Iceland.

  • Conflict of interest None.

  • Accepted 17 June 1996
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