Mack, I; Sharland, M; Berkley, JA; Klein, N; Malhotra-Kumar, S; Bielicki, J
(2019)
Antimicrobial Resistance Following Azithromycin Mass Drug Administration: Potential Surveillance Strategies to Assess Public Health Impact.
Clin Infect Dis.
ISSN 1537-6591
https://doi.org/10.1093/cid/ciz893
SGUL Authors: Sharland, Michael Roy Bielicki, Julia Anna
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Abstract
The reduction in childhood mortality noted in trials investigating azithromycin mass drug administration (MDA) for trachoma control has been confirmed by a recent large randomized controlled trial. Population-level implementation of azithromycin MDA may lead to selection of multiresistant pathogens. Evidence suggests that repeated azithromycin MDA may result in a sustained increase in macrolide and other antibiotic resistance in gut and respiratory bacteria. Current evidence comes from standard microbiological techniques in studies focused on a time-limited intervention, while MDA implemented for mortality benefits would likely repeatedly expose the population over a prolonged period and may require a different surveillance approach. Targeted short-term and long-term surveillance of resistance emergence to key antibiotics, especially those from the World Health Organization Access group, is needed throughout any implementation of azithromycin MDA, focusing on a genotypic approach to overcome the limitations of resistance surveillance in indicator bacteria. Azithromycin mass drug administration results in a sustained increase in antimicrobial resistance when implemented at a population level. Targeted risk-based metagenomics approaches complementing traditional microbiological methods are recommended for surveillance of emerging short- and long-term antimicrobial resistance.
Item Type: | Article | ||||||
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Additional Information: | This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record Ines Mack, Mike Sharland, James A Berkley, Nigel Klein, Surbhi Malhotra-Kumar, Julia Bielicki, Antimicrobial Resistance Following Azithromycin Mass Drug Administration: Potential Surveillance Strategies to Assess Public Health Impact, Clinical Infectious Diseases, , ciz893 is available online at: https://doi.org/10.1093/cid/ciz893 | ||||||
Keywords: | antimicrobial resistance, azithromycin, macrolide, mass drug administration, surveillance, antimicrobial resistance, azithromycin, macrolide, mass drug administration, surveillance, 06 Biological Sciences, 11 Medical And Health Sciences, Microbiology | ||||||
SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) | ||||||
Journal or Publication Title: | Clin Infect Dis | ||||||
ISSN: | 1537-6591 | ||||||
Language: | eng | ||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||
PubMed ID: | 31633161 | ||||||
Go to PubMed abstract | |||||||
URI: | http://sgultest.da.ulcc.ac.uk/id/eprint/111318 | ||||||
Publisher's version: | https://doi.org/10.1093/cid/ciz893 |
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