Trimethoprim prescription and subsequent resistance in childhood urinary infection: multilevel modelling analysis

Duffy, Mary A; Hernández-Santiago, Virginia; Orange, G.; Davey, Peter; Guthrie, Bruce

doi:10.3399/bjgp13x665198

Cited by 23 publications

(19 citation statements)

References 15 publications

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“…5 Consistent with our previous review, we found some evidence from Duffy and colleagues of decreasing resistance for increasing time from antibiotic prescribing. 24 Policy, clinical, and research implications 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 Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) 95 recommend that an antibiotic should be selected for first line empirical treatment of urinary tract infection only if the local prevalence of resistance is less than 20%.…”

Section: Association Between Previous Antibiotic Exposure and Bacterimentioning

confidence: 90%

“…As data reported in the UK study were analysed with a two level model of samples nested within patients, we reported it separately in our meta-analysis. 24 All studies were observational; 25 were retrospective, six prospective, and two case-control. Thirty reported information on prevalence of resistance in E coli urinary tract infection isolates, with the three remaining reporting the association between previous antibiotic exposure and E coli resistance only.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Odds ratio ( % CI) Odds ratio ( % CI) fig 4 | individual crude multilevel odds ratios for trimethoprim resistance in urinary isolates of children from Duffy and colleagues 24 and previous trimethoprim prescribing children's urinary tract infection and associations with the routine use of antibiotics in primary care. WHO recently published their "global action plan" on antimicrobial resistance, which described data relating to the prevalence of resistance, including geographical patterns, as a key gap in our current knowledge, 80 which this systematic review in part fills.…”

Section: Days a Er Exposurementioning

confidence: 99%

See 2 more Smart Citations

Global prevalence of antibiotic resistance in paediatric urinary tract infections caused byEscherichia coliand association with routine use of antibiotics in primary care: systematic review and meta-analysis

Bryce

Hay

Lane

et al. 2016

BMJ

376

256

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ObjeCtivesTo systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance. Design anD Data analysisSystematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used antibiotics in children in primary care, stratified by the OECD (Organisation for Economic Co-operation and Development) status of the study country. Random effects meta-analysis was used to quantify the association between previous exposure to antibiotics in primary care and resistance. Data sOurCesObservational and experimental studies identified through Medline, Embase, Cochrane, and ISI Web of Knowledge databases, searched for articles published up to October 2015.eligibility Criteria fOr seleCting stuDies Studies were eligible if they investigated and reported resistance in community acquired urinary tract infection in children and young people aged 0-17. Electronic searches with MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction. results 58 observational studies investigated 77 783 E coli isolates in urine. In studies from OECD countries, the pooled prevalence of resistance was 53.4% (95% confidence interval 46.0% to 60.8%) for ampicillin, 23.6% (13.9% to 32.3%) for trimethoprim, 8.2% (7.9% to 9.6%) for co-amoxiclav, and 2.1% (0.8 to 4.4%) for ciprofloxacin; nitrofurantoin was the lowest at 1.3% (0.8% to 1.7%). Resistance in studies in countries outside the OECD was significantly higher: 79.8% (73.0% to 87.7%) for ampicillin, 60.3% (40.9% to 79.0%) for co-amoxiclav, 26.8% (11.1% to 43.0%) for ciprofloxacin, and 17.0% (9.8% to 24.2%) for nitrofurantoin. 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 six months (odds ratio 13.23, 95% confidence interval 7.84 to 22.31). COnClusiOnsPrevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment.

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Section: Association Between Previous Antibiotic Exposure and Bacterimentioning

confidence: 90%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Days a Er Exposurementioning

confidence: 99%

See 1 more Smart Citation

Global prevalence of antibiotic resistance in paediatric urinary tract infections caused byEscherichia coliand association with routine use of antibiotics in primary care: systematic review and meta-analysis

Bryce

Hay

Lane

et al. 2016

BMJ

376

256

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“…Step up Duffy et al 4 who, in this month's BJGP, have published an article showing that bacterial resistance to trimethoprim in children's UTI is:…”

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confidence: 99%

Antibiotics for childhood urinary tract infection: can we be smarter?

Costelloe¹

2013

Br J Gen Pract

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“…3 Yet curiously, antibiotic-induced resistance attenuates over time. 4 For the first few months after taking an antibiotic, urine infections are five times more likely to be antibiotic resistant. Within 6 months of taking an antibiotic, the rate of resistance reverts to pre-treatment levels.…”

mentioning

confidence: 99%

Dangerous Ideas: resistant superbugs and the potential of the microbiome

2014

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Trimethoprim prescription and subsequent resistance in childhood urinary infection: multilevel modelling analysis

Abstract: BackgroundAntibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children.

Cited by 23 publications

References 15 publications

Global prevalence of antibiotic resistance in paediatric urinary tract infections caused byEscherichia coliand association with routine use of antibiotics in primary care: systematic review and meta-analysis

Global prevalence of antibiotic resistance in paediatric urinary tract infections caused byEscherichia coliand association with routine use of antibiotics in primary care: systematic review and meta-analysis

Antibiotics for childhood urinary tract infection: can we be smarter?

Dangerous Ideas: resistant superbugs and the potential of the microbiome

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