206. Antibiotic resistance compromises treatment of pneumonia in Ugandan children
Session: Poster Abstract Session: Antimicrobial Resistance: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: Acute respiratory infections (ARI) are a major cause of morbidity and mortality in Sub-Saharan Africa. The rising occurrence of antibiotic resistance (ABR) is complicating the treatment of these diseases. The aim of this work was to document the usual treatment and impact of ABR on the treatment of pneumonia in Ugandan children under 6 in outpatient settings.

Methods: Data was abstracted from registers of 2347 outpatient visits of children under 6 at 10 sites in Uganda in 2008-2009 and review of Ugandan data on ABR of S. pneumoniae and H. influenzae.

Results: 288 of 2347 (12.3%) children under 6 had a recorded diagnosis of pneumonia, of which 95 (33%) were “severe” and 193 (66%) “not severe.” A diagnosis of malaria was also recorded for 186 (64.6%) of the children and 177 (95%) received at least one antimalarial, although 9 (5%) received ineffective antimalarials, CQ and S/P. The most commonly prescribed antibiotic was cotrimoxazole (38.7%), to which ABR approaches 80% in Uganda, followed by benzyl penicillin (25.1%), amoxicillin (22.1%), and other antibiotics (14.2%).  89 (31%) of children received multiple antibiotics, of which 55 (19%) received cotrimoxazole plus a second antibiotic. However, 88 children (30.5%) received cotrimoxazole alone, and no antibiotic was recorded for 19 children (7%). Thus, approximately 37% of children seen received potentially ineffective treatment for pneumonia.

Conclusion:  Although febrile children with pneumonia are frequently seen in outpatient settings, and antibiotic therapy is almost always prescribed, many received either cotrimoxazole (80% ABR) or no antibiotic at all, thus therapy was ineffective or absent in about 37% of cases.  This may contribute to high mortality from pneumonia despite empirical treatment. Uganda’s standard treatment was cotrimoxazole but has recently been changed to amoxicillin. Children with a pneumonia diagnosis were almost as likely to receive an antimalarial (58%) as an effective antibiotic (63%).  Prescribers need to be made more aware of high levels of ABR to cotrimoxazole, and alternative antibiotics should be provided in Uganda.


Subject Category: A. Antimicrobial agents and Resistance

SD Foster1, D OCHIENG2, A Sosa2 and CF NAJJUKA3, (1)Alliance for the Prudent Use of Antibiotics, , Boston, MA, (2)Alliance for the Prudent Use of Antibiotics, Boston, MA, (3)Makerere University, Kampala, Uganda

Disclosures:

S. Foster, None

D. OCHIENG, None

A. Sosa, None

C. NAJJUKA, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.