# Co-selection of genetic antibiotic resistance in Streptococcus pneumoniae after repeated azithromycin mass drug administrations in Niger

## TL;DR

Repeated azithromycin use in Niger led to increased genetic resistance in Streptococcus pneumoniae to multiple antibiotics.

## Contribution

This study demonstrates co-selection of resistance to multiple antibiotics due to repeated azithromycin mass drug administrations.

## Key findings

- Genetic resistance to macrolide antibiotics was detected in S. pneumoniae after repeated azithromycin use.
- Resistance to tetracycline and trimethoprim-sulfamethoxazole also increased in treated communities.
- The study highlights the risk of antibiotic resistance spread through mass drug administration programs.

## Abstract

The spread of antibiotic resistance is a major concern in the setting of azithromycin mass drug distribution for childhood mortality. We performed long-read whole-genome sequencing and phenotypic resistance analysis on Streptococcus pneumoniae isolated from the nasopharynx of Nigerien children from communities treated with either six twice-yearly azithromycin distributions or placebo. Here, we showed that co-selection for macrolide, tetracycline, and trimethoprim-sulfamethoxazole genetic resistance was detected with repeated azithromycin mass drug distributions.

This study is registered with ClinicalTrials.gov as NCT02047981.