Treatment For One Drug-Resistant Disease Leads To Second Drug-Resistant Disease

An article published in the journal The Lancet
reports that using fluoroquinones to treat children with tuberculosis
that is resistant to multiple drugs has led to the development of
pneumococci in children that is also resistant to this class of drugs.



The
conclusions of the study conducted by Dr Anne von Gottberg (National
Institute for Communicable Diseases, Gauteng, South Africa) and
colleagues came from an analysis of 21,521 cases of invasive
pneumococcal disease, such as severe pneumonia and meningitis, between
2000 and 2006. The researchers screened 90% of the cases (19,404
isolates) for resistance to a fluoroquinone called ofloxacin. Patients
were deemed levoflaxacin-resistant if they had minimum inhibitory
concentrations (MIC) of 4 mg/L or more. MIC is lowest concentration of
an antimicrobial that will inhibit the visible growth of a
microorganism after overnight incubation. The authors assessed 65
children for carrying nose and throat pneumococcal in two tuberculosis
hospitals that were known to have invasive pneumococcal disease caused
by levofloxacin-resistant Streptococcus pneumoniae.



There
were 12 cases of levofloxacin-resistant, invasive pneumococcal disease
found in children, all of whom were less than 15 years old. Five of the
patients died of the eleven whose outcomes were known. The
researchers found an association between invasive pneumococcal disease
caused by levofloxacin-resistant S pneumoniae and a history of TB
treatment. That is, 89% of children (8 of 9) with
non-susceptible isolates were treated for TB, and 18% of children (396
of 2202) with susceptible isolates were treated.



The
researchers also found that among children hospitalized who carried
nose and throat pneumococcal, almost all of these bacteria were
resistant to levofloxacin.



"Our data suggest that the use of
fluoroquinones to treat multidrug-resistant tuberculosis in children
has led to the emergence of invasive pneumococcal diseases caused by levofloxacin-non-susceptible S pneumoniae and its nosocomial spread
among children," write the authors.



Emergence of levofloxacin-non-susceptible Streptococcus
pneumoniae and treatment for multidrug-resistant tuberculosis
in children in South Africa: a cohort observational surveillance study

Anne von Gottberg, Keith P Klugman, Cheryl Cohen, Nicole
Wolter,
Linda de Gouveia, Mignon du Plessis, Ruth Mpembe, Vanessa Quan, Andrew
Whitelaw, Rena Hoffmann, Nelesh Govender, Susan Meiring, Anthony M
Smith, Stephanie Schrag.

The Lancet (2008). 371[9618]:1108-1113.

doi:10.1016/S0140-6736(08)60350-5



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: Peter M Crosta






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