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Antibiotic resistance in children is high and associated with previous antibiotic use

16 March 2016

Antibiotic resistance in children with urinary infections is high and could render some antibiotics ineffective as first-line treatments, warns a study published by The BMJ today.

Antimicrobial resistance is an internationally recognised threat to health. Throughout the world, children are frequent consumers of antibiotics - and such routine use has been shown to increase the probability of antibiotic resistance in adults with urinary tract infections.

Yet little is known about the prevalence of bacterial resistance in children or the risk factors of importance in this group.

So a team of UK researchers from University of Bristol and Imperial College London set out to review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli, a bacterium responsible for over 80% of all urinary tract infections in children. The team also set out to measure the association between previous exposure to antibiotics and subsequent resistance in the same child.

They reviewed the results of 58 observational studies in 26 countries involving over 77,000 E. coli samples. Although observational studies cannot tell us about cause and effect, meta-analysis of observational data is useful for pulling evidence together.

The results show a high global prevalence of resistance - to some of the most commonly prescribed antibiotics in primary care - in urinary tract infections in children caused by E coli.

Results were categorised by the OECD (Organisation for Economic Co-operation and Development) status of the study country as antibiotics tend to be used differently in these groups.

Within OECD countries, half of all samples were resistant to ampicillin (amoxicillin), a third to co-trimoxazole, and a quarter to trimethoprim. Resistance was substantially greater in non-OECD countries.

Lead author Ashley Bryce, PhD student at the Centre for Academic Primary Care, University of Bristol highlights that “Prevalence 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.”

Dr Céire Costelloe, who co-led the research at the Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, points out that “the results also suggest previous antibiotic use increased the subsequent risk of E coli resistance to that particular antibiotic - for up to six months after treatment.”

In an accompanying editorial, Professor Grant Russell at Monash University in Australia describes how this review joins a host of recent studies, reports, and calls to action on this issue presenting “compelling evidence of the need to reconsider current approaches to community based management of paediatric urinary tract infection.”

However, he concludes: “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.”


Further information

Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis
Ashley Bryce, Alastair D Hay, Isabel F Lane, Hannah V Thornton, Mandy Wootton, Céire Costelloe

Antibiotic resistance in children with E coli urinary tract infection
Grant Russel

Ashley Bryce is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The NIHR is the research arm of the NHS.

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website

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