Impact of antibiotic consumption on the carriage of antibiotic-resistant bacteria by school children

Abstract

Background Antibiotic consumption in the paediatric population is one of the key drivers of the emergence and spread of antimicrobial resistance, which is a serious global threat to public health and clinical medicine. The aims of this study were to investigate systemic antibiotic consumption in school children and to assess the associations among antibiotic consumption, carriage rate and resistance of respiratory pathogens residing in the upper respiratory tract mucosa. Methods In this prospective study, throat and nasopharyngeal swabs from 450 school children, 6–15 years of age (225 healthy children and 225 patients who were ambulatory treated for upper respiratory tract infection), were processed in 2014 in Rijeka, Croatia, and clinical data were obtained via a questionnaire. Results In total, 17% of the children had consumed an antibiotic in the previous 6 months, including 7% of the healthy children and 27% of the acutely ill patients. The most commonly prescribed antibiotics were amoxicillin (26%), amoxicillin with clavulanic acid (26%) and macrolides (18%). Respiratory pathogens were more frequently isolated from children who had consumed an antibiotic in the previous 6 months [odds ratio (OR) 3.67, P < 0.001]. Antibiotic-resistant bacteria were also more frequent in children who had been exposed to antibiotics (OR 5.44, P < 0.001). Conclusions Penicillins are the most frequently used antibiotics among school children. The results of this study demonstrate that antibiotic consumption is linked with higher carriage rates and resistance rates of respiratory tract pathogens. Therefore, rational use of antibiotics could prevent the emergence and spread of resistant bacteria.

Pediatric tertiary emergency care departments in Zagreb, Rijeka, and Split before and during the coronavirus disease 2019 pandemic: a Croatian national multicenter study

“…These data correspond to local antimicrobial resistance -eg, centers with a high prescription rate of azithromycin have more azithromycin-resistant group A Streptococcus (up to 15%), which is still in an upward trend (52,53). Increasing prescription trends of amoxicillin/clavulanate, azithromycin, and second/third generation cephalosporins in Croatia have been observed for more than 15 years, with limited improvement (54)(55)(56). This is supported by our study, where oral cephalosporins accounted to 17% of all prescribed antibiotics, with 85% of them belonging to the second and third generation.…”

Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis

“…Our systematic review suggests while many children younger than five years were treated with antivirals, 71% were treated with antibiotics, despite having a confirmed diagnosis of COVID-19. This is a concerning proportion of antibiotic use as a treatment for the viral disease in children, given the inappropriate use of antibiotics in under five children is a significant contributor to the emergence and spread of antimicrobial resistance globally [98] , [99] . While prophylactic treatment with antibiotics in infants with unknown source of infection, is routine in preventing bacteraemia, urinary tract infection (UTI) or pneumonia, this still has limitations in populations of increased antimicrobial resistance [100] , [101] .…”

Antibiotic prescription for children with acute respiratory tract infections in rural primary healthcare in Guangdong province, China: a cross-sectional study

“…Similarly, most of the third-generation cephalosporins and macrolides are classified as watch or reserve antibiotics in the 2021 WHO Access, Watch and Reserve (AWaRe) classification and need to be used with caution for specific infections or can only be used when other alternative treatments are not effective 40. Thus, poor adherence to the antibiotic guidelines as identified in our study, especially the widely used broad-spectrum antibiotics to treat children with ARIs, will further accelerate the development of AMR in children and needs to be addressed urgently 13 41…”