Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Antibiotic Selection Pressure & Macrolide Resistance

Clin Infect Dis; ePub 2018 Apr 20; Keenan, et al

In a recent cluster-randomized trial comparing 2 different frequencies of mass azithromycin distributions for trachoma, communities randomized to less frequent use of antibiotics had a significantly lower prevalence of genetic antibiotic resistance determinants. 24 communities were randomized to either annual or biannual mass azithromycin distributions for trachoma. Swabs were processed for the genetic macrolide resistance determinants ermB and mefA/E in a masked fashion from a random sample of 120 preschool children before treatment and another 120 children after 2 years of mass antibiotics. Researchers found:

  • Macrolide resistance determinants were similar in the 12 annually and 12 biannually treated communities before treatment, with a median prevalence among preschool children of 20%.
  • By 24 months, macrolide resistance determinants were found more commonly in the biannually treated communities vs the annually treated communities (median 60% vs 40%).
  • The 24-month prevalence of macrolide resistance determinants in the biannual group was 29.4% higher vs the annual group, after adjusting for baseline.


Keenan JD, Chin SA, Amza A, et al. The effect of antibiotic selection pressure on the nasopharyngeal macrolide resistome: A cluster-randomized trial. [Published online ahead of print April 20, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy339.

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