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Prior antibiotic use associated with high resistance prevalence in children with UTI
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High antibiotic resistance among children with urinary tract infections caused by Escherichia coli was associated with previous antibiotic use and may persist for up to 6 months after treatment, according to recent research in BMJ.
“We conducted a systematic review to investigate the prevalence of resistance in community acquired E. coli urinary tract infection to the most commonly prescribed antibiotics given to children,” Ashley Bryce, PhD, BSc, of the Centre for Academic Primary Care at the NIHR School for Primary Care Research at the University of Bristol, and colleagues wrote. “Our findings detail global high-level resistance to some of the most commonly prescribed antibiotics for children primary care, which could result in several drugs becoming ineffective first-line treatments in many countries.”
The researchers reviewed 58 published observational studies related to antibiotic use among children with urinary tract infections (UTI). There were 77,783 individual urine samples and E. coli isolates collected across the analyzed research. Further meta-analysis determined the relationship between antibiotics prescribed to children and resistance rates. Results from 26 countries were included in the study population. The researchers classified results based on the Organization for Economic Cooperation and Development (OECD) status of study countries, due to the variance in antibiotic use between countries.
Study results showed that within OECD member countries, resistance prevalence was 53.4% for ampicillin, 30.2% for co-trimoxazole, 23.6% for trimethoprim, 8.2% for co-amoxiclav, 2.1% for ciprofloxacin and 1.3% for nitrofurantoin. The researchers found that resistance was significantly higher in non-OECD member countries; resistance prevalence was 79.8% for ampicillin, 69.6% for co-trimoxazole, 60.3% for co-amoxiclav, 26.8% for ciprofloxacin and 17% for nitrofurantoin.
Bryce and colleagues also found evidence that bacterial isolates for UTI from children who had previously been prescribed antibiotics were more likely to be resistant to antibiotics, and could maintain this resistance for up to 6 months (OR = 13.23; 95% CI, 7.84-22.31).
“Our results also support the need for prescribing guidelines to reflect patterns of local resistance and that, for many areas, nitrofurantoin might be the most appropriate first-line treatment for lower urinary tract infection,” Bryce and colleagues wrote. “That said, care is needed because ruling out the use of some first-line antibiotics could lead clinicians to prescribe broad-spectrum, second-line antibiotics, such as co-amoxiclav, cephalosporins and quinolones, resulting in a vicious cycle of increasing use of broad-spectrum antibiotics and bacterial resistance.”
In a related editorial, Grant Russell, PhD, professor of general practice research at the School of Primary Health Care at Monash University in Melbourne, Australia, wrote that Bryce and colleagues provided “compelling evidence” for the urgent need to reconsider treatment methods for community-acquired UTIs in children.
“Bryce and colleagues’ systematic review joins a host of recent studies, reports, and calls to action on this issue,” Russell wrote. “Each adds evidence to justify change in how we protect a precious global resource. While I have no doubt that clinical practice guidelines will quickly be able to accommodate the findings, I am less confident that there is the will and commitment to deal with what the WHO has called ‘the post-antibiotic era.’ ” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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