Pediatric Antibiotic Prescribing Still Risks High Level Of Antibiotic Resistance

Editor's Choice
Main Category: Pediatrics / Children's Health
Also Included In: MRSA / Drug Resistance;  Infectious Diseases / Bacteria / Viruses;  Public Health
Article Date: 27 Jul 2007 - 0:00 PDT

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Experts warn that the rate of antibiotic prescribing in the UK community is still poses a risk that levels of antibiotic resistance in the population remain elevated, say specialists in an article in the BMJ Online First
British Medical Journal (BMJ).

Author Davit Mant, University of Oxford, says that the prescribing of antibiotics to children in the UK is still common practice, he urges GPs to cut down in order to lower the threat of drug resistance.

A 1999 study reported that 55% of very young children (aged 0-5) in the UK receive roughly 2.2 prescriptions for a β-lactam antibiotic like amoxicillin annually from their GP.

Even though antibiotic prescribing has dropped by about 40% since 1999, mainly as a result of doctors following a recommendation that they wait 24-48 hours before filling out a prescription, unpublished data indicates that antibiotic prescribing is on the way up yet again.

This news report mentions a study which stated that despite national guidance, doctors continue to prescribe antibiotics for too many patients with lesser infections. The team therefore decided to find out what impact this might have on antibiotic resistance in individual children in primary care.

119 children in Oxfordshire, who were being treated by their GPs for acute respiratory tract infection, were identified. 71 of them received amoxicillin (a β-lactam antibiotic), while 48 were not given any antibiotic at all. They had access to background medical information. Throat swabs were taken of the 119 children at the beginning of the study, and then several times for 12 weeks. They were looking for the presence of resistant bacteria, which have a gene which codes for antibiotic resistance. Their findings were as follows:

-- The proportion of those carrying resistant bacteria in the throat among the children who did not receive an antibiotic remained the same throughout the 12 weeks

-- The proportion of those carrying resistant bacteria in the throat among the children who did receive an antibiotic almost doubled after 2 weeks and then settled back close to initial levels after 12 weeks

The authors say the study demonstrated that if a GP prescribes a a β-lactam antibiotic to a child, that child's risk of having an a β-lactam antibiotic resistant element in his/her throat two weeks later is higher. Even though their levels went back to near normal at the end of the 12 weeks, it may be enough to sustain a high level of antibiotic resistance in the population.

Doctors will need to modify their approach to prescribing antibiotics to kids substantially and in a sustained way, say the authors, if we are to reduce resistance rates. They added that treatment courses could be shorter, while the prescribing of antibiotics should be well defined and in exceptional circumstances.

"Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study"
BMJ Online First
http://www.bmj.com

Written by: Christian Nordqvist
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