For example, a study in Atlanta showed that bacterial infections among inner city children are less likely to be antibiotic resistant than those among more well-off children in the suburbs, who have better access to health care and antibiotics. We have seen contrasting results in South Africa. In lower socioeconomic groups there tends to be a lot of penicillin resistance because penicillin is frequently given out at public health clinics. In more affluent communities, there is less resistance to penicillin but more resistance to erythromycin, because that's what doctors there more often prescribe. Prescription patterns also relate to a patient's age.
Young children tend to get more antibiotics and thus have more resistance.
In South Africa, the most dire problem with antibiotic-resistant bacteria is associated with HIV infection. The reason is that, like very young children, HIV-infected patients tend to be prescribed antibiotics more often. Before moving to the United States, Klugman was a professor at the University of Witwatersrand in Johannesburg. He plans to continue his work there as director of the Pneumococcal Diseases Research Unit of the Medical Research Council. In addition to his primary position at RSPH, he holds joint appointments in the Emory School of Medicine and the Centers for Disease Control and Prevention.