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Objectives  To evaluate the impact of one oral dose of intrapartum azithromycin (2 g) on the carriage and antibiotic resistance of  Escherichia coli  and  Klebsiella pneumoniae  in the nasopharynx, breast milk and vaginal swabs of mothers and  K. pneumoniae  in the nasopharynx of their newborns.    Methods  We performed a post hoc analysis of a double-blind, placebo-controlled randomized-trial (ratio 1:1) conducted in The Gambia. Breast milk (BM) and vaginal swabs (VS) from mothers and nasopharyngeal swabs (NPS) from mother–newborn pairs were collected at different timepoints during the 4 week follow-up. Samples were processed using standard microbiological procedures. For BM and NPS post-intervention results were combined for analysis.    Results  In the original trial 829 mothers were randomized. In this analysis, complete sample sets were available for 630 mothers for  E. coli  analysis (76.0%) and 564 mother–newborn pairs for  K. pneumoniae  analysis (68.0%). For  E. coli , carriage prevalence in BM and VS was similar in both arms but resistance was higher in the azithromycin arm in VS (2.6% versus 0%,  P =  0.004). For  K. pneumoniae , carriage prevalence was higher in the azithromycin arm for BM (13.8% versus 8.7%,  P =  0.055) but not for VS or NPS. Prevalence of azithromycin resistant  K. pneumoniae  was higher in the azithromycin arm for BM (3.6% versus 1.0%,  P =  0.050) and VS (1.5% versus 0%  P =  0.057).    Conclusions  Oral intrapartum azithromycin did not reduce carriage of  E. coli  and  K. pneumoniae  and was associated with an increase in the prevalence of azithromycin-resistant  E. coli  and  K. pneumoniae  isolates in BM and VS.

jac-antimicrobial resistance

Short-term increase in the carriage of azithromycin-resistant <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> in mothers and their newborns following intra-partum azithromycin: a post hoc analysis of a double-blind randomized trial

Short-term increase in the carriage of azithromycin-resistant Escherichia coli and Klebsiella pneumoniae in mothers and their newborns following intra-partum azithromycin: a post hoc analysis of a double-blind randomized trial