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- Title
Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomized trial.
- Authors
Schrag SJ; Peña C; Fernández J; Sánchez J; Gómez V; Pérez E; Feris JM; Besser RE; Schrag, S J; Peña, C; Fernández, J; Sánchez, J; Gómez, V; Pérez, E; Feris, J M; Besser, R E
- Abstract
<bold>Context: </bold>Emerging drug resistance threatens the effectiveness of existing therapies for pneumococcal infections. Modifying the dose and duration of antibiotic therapy may limit the spread of resistant pneumococci.<bold>Objective: </bold>To determine whether short-course, high-dose amoxicillin therapy reduces risk of posttreatment resistant pneumococcal carriage among children with respiratory tract infections.<bold>Design and Setting: </bold>Randomized trial conducted in an outpatient clinic in Santo Domingo, Dominican Republic, October 1999 through July 2000.<bold>Participants: </bold>Children aged 6 to 59 months who were receiving antibiotic prescriptions for respiratory tract illness (n = 795).<bold>Interventions: </bold>Children were randomly assigned to receive 1 of 2 twice-daily regimens of amoxicillin: 90 mg/kg per day for 5 days (n = 398) or 40 mg/kg per day for 10 days (n = 397).<bold>Main Outcome Measures: </bold>Penicillin-nonsusceptible Streptococcus pneumoniae carriage, assessed in nasopharyngeal specimens collected at days 0, 5, 10, and 28; baseline risk factors for nonsusceptible pneumococcal carriage; and adherence to regimen, compared between the 2 groups.<bold>Results: </bold>At the day 28 visit, risk of penicillin-nonsusceptible pneumococcal carriage was significantly lower in the short-course, high-dose group (24%) compared with the standard-course group (32%); relative risk (RR), 0.77; 95% confidence interval (CI), 0.60-0.97; P =.03; risk of trimethoprim-sulfamethoxazole nonsusceptibility was also lower in the short-course, high-dose group (RR, 0.77; 95% CI, 0.58-1.03; P =.08). The protective effect of short-course, high-dose therapy was stronger in households with 3 or more children (RR, 0.72; 95% CI, 0.52-0.98). Adherence to treatment was higher in the short-course, high-dose group (82% vs 74%; P =.02).<bold>Conclusion: </bold>Short-course, high-dose outpatient antibiotic therapy appears promising as an intervention to minimize the impact of antibiotic use on the spread of drug-resistant pneumococci.
- Publication
JAMA: Journal of the American Medical Association, 2001, Vol 286, Issue 1, p49
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.286.1.49