Use of antimicrobials and carriage of penicillin-resistant pneumococci in children : repeated cross-sectional studies covering 10 years [PhD Thesis]

• Main Author: Vilhjálmur Ari Arason
• Format: Thesis
• Language: English
• Published: Háskólaútgáfan 2007
• Subjects: Sýklalyf; Börn; Eyrnabólga; Doktorsritgerðir; Lyfjanotkun; Ísland; Heimilislækningar; Dissertations; Academic; Penicillins; Iceland; Child Health Services; Prescriptions; Drug; Anti-Infective Agents; Otitis Media; Infant; Child; Preschool; Pneumococcal Infections; Primary Health Care; Prevalence; Middle Ear Ventilation; Penicillin Resistance; Microbiology; Anti-Bacterial Agents; Smella
• Online Access: http://hdl.handle.net/2336/11250

Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn View/Open Objectives: The overall aim of this thesis was to analyse the use of antimicrobials in pre-school children in Iceland and the connection between such use and the carriage of penicillin-nonsusceptible pneumococci(PNSP). Study populations and methods: Prescription data and medical histories from 2,612 children, aged 1 to 6 years, living in different geographically welldefined study areas in Iceland, and nasopharyngeal specimens from 2,486 children were analysed in three crosssectional studies covering 10 years (Phase I 1993, II 1998, and III 2003). Participation varied from 75% to 88%. Annual analysis of oral antimicrobial sales/prescriptions for whole communities (hospital use excluded) were based on 22,132 prescriptions in 1993, and 15,153 in 1998. Main outcome measures: The prevalence and risk factors for nasopharyngeal carriage of PNSP, total antimicrobial use, antimicrobial use for acute otitis media (AOM), parental expectations and tympanostomy tube placements. Results: • Antimicrobial prescription rates among GPs diminished by about 1/3 over the study period. Prescription habits varied greatly between communites especially because of AOM. • Parents’ expectations of antimicrobial prescriptions were associated with the antimicrobial prescription rate in each area. • The cumulative prevalence of tympanostomy tube placement among pre-school children is high in Iceland (over 30%). In vi areas where the prescription rate was high, broad-spectrum antimicrobials were prescribed relatively more often than in other areas, and the tympanostomy tube placement rate was increasing (up to 44% of all children). In other areas, tympanostomy tube rate among children deceased (down to 17%) at the same time as antimicrobial use for AOM diminished. • There was a strong association between antimicrobial use on the individual level and the nasopharyngeal carriage of PNSP. • PNSP, multiresistant, serotype 6B (phenotypically ...