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15 June 2002

Volume 34, Number 12
Clinical Infectious Diseases 2002;34:1543–1550
1058-4838/2002/3412-0001
DOI: 10.1086/340534
MAJOR ARTICLE

Changes in Antibiotic‐Prescribing Practices and Carriage of Penicillin‐Resistant Streptococcus pneumoniae: A Controlled Intervention Trial in Rural Alaska

Thomas W. Hennessy,1

Kenneth M. Petersen,1

Dana Bruden,1

Alan J. Parkinson,1

Debby Hurlburt,1

Marilyn Getty,1

Benjamin Schwartz,2,a and

Jay C. Butler1

1Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska; and 2Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

From 1998 to 2000, 13 rural Alaskan villages (population, 3326) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage. Data regarding antibiotic use for the entire population was abstracted from clinic records. In 1999, education of medical providers and the community about appropriate antibiotic use began in 4 villages; this program was expanded to include all villages in 2000. Antibiotic courses per person decreased by 31% in the initial intervention villages and by 35% in the remaining villages after education ( for each). Samples were obtained for culture from a mean of 31% of the population each year; 31% carried pneumococcus. No sustained decrease in carriage of penicillin‐nonsusceptible strains was observed. When linear regression was used, serotype accounted for 81% of the variance in pneumococcal minimum inhibitory concentrations after the intervention, compared with 7% for antibiotic use. This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short‐term impact than does decreasing antibiotic use.

Received 21 September 2001; revised 17 January 2002; electronically published 21 May 2002.

Reprints or correspondence: Dr. Thomas Hennessy, Arctic Investigations Program, National Center for Infectious Diseases, Centers of Disease Control and Prevention, 4055 Tudor Centre Dr., Anchorage, AK 99508 ().

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  • Financial support: US Department of Health and Human Services, Centers for Disease Control and Prevention. Some patient education materials were provided by the Alliance for Prudent Use of Antibiotics.

  • Present affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia.

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