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High prevalence of antibiotic resistance seen in pediatric UTIs
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A meta-analysis of nearly 78,000 cases of pediatric urinary tract infections caused by Escherichia coli in 26 countries showed a high prevalence of resistance to common antibiotics.
The prevalence was particularly high in nonmembers of the Organization for Economic Cooperation and Development (OED), possibly because antibiotics in those developing countries are obtainable over-the-counter without a prescription, researchers noted in BMJ.
“This could render some drugs ineffective as first-line treatments for urinary tract infection,” they wrote.
Drug resistance high outside OECD
After scouring various databases for relevant literature and winnowing the number of studies from 4,246 down to 58 that fit their criteria, the researchers reported on resistance to common antibiotics for UTIs in children.
Globally, the prevalence of resistance was highest for ampicillin and lowest for nitrofurantoin, regardless of membership in OECD.
In OECD countries, 53.4% of samples were resistant to ampicillin (95% CI, 46-60.8) and 23.6% were resistant to trimethoprim (95% CI, 13.9-32.3) — the highest two numbers. Resistance to nitrofurantoin was 1.3% (95% CI, 0.8-1.7).
Resistance was significantly higher outside the OECD, including in 79.8% of samples for ampicillin (95% CI, 73-87.7). Although resistance was lowest for nitrofurantoin, it was still 17% (95% CI, 9.8-24.2).
In addition, the researchers noted, “There was evidence that bacterial isolates from the urinary tract from individual children who had received previous prescriptions for antibiotics in primary care were more likely to be resistant to antibiotics, and this increased risk could persist for up to 6 months (OR = 13.23; 95% CI, 7.84-22.31).”
Evidence strong to reconsider UTI approach
In a related editorial, Grant Russell, PhD, head of the school of primary health care at Monash University in Australia, said the researchers presented “compelling evidence of the need to reconsider current approaches to community-based management of pediatric urinary tract infection.”
“Their findings confront long established patterns of practice and are inextricably linked to the emerging global problem of antimicrobial resistance,” Russell wrote.
He noted that the findings match dramatic increases in resistance to common drugs for Streptococcus pneumonia, Klebsiella pneumonia, and Staphylococcus aureus infections.
“As is so often the case,” Russell wrote, “the consequences have the greatest impact in the developing world.”
In conclusion, he saw reasons to be both optimistic and pessimistic.
“While I have no doubt that clinical practice guidelines will quickly be able to accommodate the findings,” Russell wrote, “I am less confident that there is the will and commitment to deal with what the WHO has called ‘the post-antibiotic era.’” – by Gerard Gallagher
Disclosure: The researchers and Russell report no relevant financial disclosures.
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