Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence studyBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7054.387 (Published 17 August 1996) Cite this as: BMJ 1996;313:387
All rapid responses
Now eleven years from this published article in BMJ; Do
antimicrobials increase the carriage rate of penicillin resistant
pneumococci in children? Cross sectional prevalence study (1996;313: 387-
91) and after finishing follow up studies afterward 1998 and 2003,
published in 4 articles 1-4) I want to give BMJ readers opportunity to
reed the final conclusions published in my PhD thesis; Use of
Antimicrobials and Carriage of Penicillin-Resisant Pneumococci in Children
repeated cross-sectional studies covering 10 years.
In contemporary Western societies, infections from the upper
respiratory tract, especially acute otitis media in children are the most
common reasons for visiting a doctor in primary health care. The
prevalence of penicillin-resistant Streptococcus pneumoniae is highest in
countries with relatively unrestricted antimicrobial use. It has been low
in northern Europe except Iceland where strong association has been shown
with carriage of these penicillin-resistant pneumococci among children and
antimicrobial use. The most interesting is the interaction between
selective antimicrobial pressure and clonal dynamics of PNSP Spain6B-2 in
our communities. This is shown by comparisons of individual linked data
with group level data in relation to antibiotic use and resistance that
can only be obscured by group level ecological studies. Parents'
expectations of antimicrobial prescriptions are associated with the
doctor's handling of upper respiratory tract infections and there are
possibility of a causative, positive correlation between antimicrobial
drug (over)use for acute otitis media and future episodes of otitis media
and tympanostomy tube placement later that warrants further investigation.
1) Arason, V.A., A. Gunnlaugsson, J.A. Sigurdsson, H. Erlendsdottir, S.
Gudmundsson and K.G. Kristinsson Clonal spread of resistant pneumococci
despite diminished antimicrobial use. Microb Drug Resist 2002;8(3): 187-
2) Arason, V.A., J.A. Sigurdsson, K. G. Kristinsson and S. Gudmundsson.
Tympanostomy tube placements, sociodemographic factors and parental
expectations for management of acute otitis media in Iceland. Pediatr
Infect Dis J 2002;21(12): 1110-5.
3) Arason, V.A., J.A. Sigurdsson, K.G. Kristinsson, L. Getz and S.
Gudmundsson. Otitis media, tympanostomy tube placement, and use of
antibiotics. Cross-sectional community study repeated after five years.
Scand J Prim Health Care. 2005;23: 184-91.
4) Arason, V.A., J.A. Sigurdsson, H. Erlendsdottir, S. Gudmundsson and
K.G. Kristinsson. The role of antimicrobial use in the epidemiology of
resistant pneumococci:a 10 years follow up. Microb Drug Resist 2006;12;169
Competing interests: No competing interests