Pediatr Infect Dis J, 2000;19:438–44 Vol. 19, No. 5 Copyright © 2000 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A. Antimicrobial resistance of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in the Central African Republic ALEXANDER K. ROWE, MD, MPH, MICHAEL S. DEMING, MD, MPH, BENJAMIN SCHWARTZ, MD, AVRIL WASAS, MT, DEBORAH ROLKA, MS, HENRY ROLKA, MS, JUSTIN NDOYO, MD, MPH AND KEITH P. KLUGMAN, MBBCH, PHD, FRCPATH Background. To assist the Central African Re- public (CAR) develop national guidelines for treating children with pneumonia, a survey was conducted to determine antimicrobial resistance rates of nasopharyngeal isolates of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI). Secondary purposes of the survey were to identify risk factors associated with carriage of a resistant isolate and to compare the survey meth- ods of including only children with pneumonia vs. including all ill children. Methods. A cross-sectional survey of 371 ill children was conducted at 2 outpatient clinics in Bangui, CAR. Results. In all 272 SP isolates and 73 HI isolates were cultured. SP resistance rates to penicillin, trimethoprim-sulfamethoxazole (TMP-SMX), tet- racycline and chloramphenicol were 8.8, 6.3, 42.3 and 9.2%, respectively. All penicillin-resistant SP isolates were intermediately resistant. HI resis- tance rates to ampicillin, TMP-SMX and chloram- phenicol were 1.4, 12.3 and 0%, respectively. The most common SP serotypes/groups were 19, 14, 6 and 1; 49% of HI isolates were type b. History of antimicrobial use in the previous 7 days was the only factor associated with carriage of a resis- tant isolate. Resistance rates were similar among ill children regardless of whether they had pneu- monia. Conclusions. Resistance rates were low for an- timicrobials recommended by the World Health Organization for children with pneumonia. We recommended TMP-SMX as the first line treat- ment for pneumonia in CAR because of its low cost, ease of dosing and activity against malaria. INTRODUCTION To reduce childhood deaths from pneumonia in the Central African Republic (CAR), the government is implementing an acute respiratory infection (ARI) con- trol program developed by WHO (unpublished CDC foreign trip report by Stephen Redd, May 1992). 2 The key intervention is to treat children with pneumonia, as defined by a simple clinical algorithm, with an antimicrobial active against Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI). 3, 4 WHO cur- rently recommends trimethoprim-sulfamethoxazole (TMP-SMX), amoxicillin or procaine penicillin as first line agents for outpatient therapy of pneumonia. We conducted a survey of antimicrobial resistance to help develop national treatment recommendations and to understand better the epidemiology of resistant SP and HI in central Africa. 5–8 In designing the survey we reviewed a draft set of WHO guidelines for conducting SP and HI resistance surveys in developing countries. 9 These guidelines rec- ommended studying nasopharyngeal (NP) isolates from children with WHO-defined pneumonia. This method is supported by studies showing that resistance Accepted for publication Jan. 26, 2000. From the Epidemic Intelligence Service (AKR); International Child Survival and Emerging Infections Program Support Activ- ity, Division of Parasitic Diseases, National Center for Infectious Diseases (AKR, MSD); Epidemiology and Surveillance Division (BS), Statistical Analysis Branch, Data Management Division (HR), National Immunization Program; and Epidemiology and Statistics Branch, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion (DR), Centers for Disease Control and Prevention, Atlanta, GA; Pneumococcal Diseases Research Unit, Department of Clinical Microbiology and Infectious Diseases, University of Witwa- tersrand and the South African Institute for Medical Research, Johannesburg, South Africa (AW, KPK); and Directorate of Pre- ventive Medicine (JN), Ministry of Public Health and Population, Bangui, Central African Republic. Preliminary findings from this study were published 1 and presented in a poster at the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy, September, 1995. Key words: Streptococcus pneumoniae, Haemophilus influen- zae, pneumonia, acute respiratory tract infection, antimicrobial resistance, Central African Republic, developing countries, equiv- alence testing, epidemiologic methods. Address for reprints: Dr. Alexander K. Rowe, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341. Fax 770-488-4203; E-mail axr9@cdc.gov. 438