| Summary: | <p>Abstract</p> <p>Background</p> <p><it>Streptococcus pneumoniae </it>is the most significant bacterial cause of community-acquired pneumonia among children under five years worldwide. Updated resistance information of <it>S. pneumoniae </it>among children is essential to adjust the recommendations for empirical treatment of community-acquired pneumonia, which will have immense implications for local and global health. This study investigated the prevalence of antibiotic resistance in isolated strains of <it>S. pneumoniae </it>and relationship with antibiotic use and demographic factors of children under five in rural Vietnam in 2007.</p> <p>Methods</p> <p>In Bavi district, 847 children 6 to 60 months were selected from 847 households. The main child-caregivers in the households were interviewed weekly using structured questionnaires to collect information of daily illness symptoms and drug use for the selected child over a four-week period (from March through June 2007). In the 3<sup>rd </sup>week, the children were invited for a clinical examination and to collect nasopharyngeal samples for <it>S. pneumoniae </it>identification. Etest and disk diffusion were used to test antibiotic susceptibility.</p> <p>Results</p> <p>Of 818 participating children, 258 (32%) had ongoing respiratory infections, 421 (52%) carried <it>S. pneumoniae</it>, and 477 (58%) had used antibiotics within the previous three weeks. Of the 421 isolates, 95% were resistant to at least one antibiotic (401/421). Resistance to co-trimoxazole, tetracycline, phenoxymethylpenicillin, erythromycin and ciprofloxacin was 78%, 75%, 75%, 70% and 28%, respectively. Low resistance was noted for amoxicillin (4%), benzylpenicillin (4%), and cefotaxime (2%). The intermediate resistance to amoxicillin was 32%. Multidrug-resistance was seen in 60%. The most common pattern was co-resistance to co-trimoxazole, tetracycline and erythromycin. The proportion of children carrying resistant bacteria was higher among the children who had used antibiotics in the previous three weeks.</p> <p>Conclusions</p> <p>Resistance to commonly used antibiotics and multidrug-resistance of <it>S. pneumoniae </it>in the area is remarkably high. High-dose amoxicillin is the only investigated oral antibiotic that can possibly be used for treatment of community-acquired pneumococcal infections. Strategies to promote appropriate prescribing and dispensing of effective antibiotics should be immediately implemented for the benefit of local and global health.</p>
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