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Common antibiotics linked to E. coli resistance in children

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Primary care prescribers should consider curbing scripts for antibiotics in children with urinary tract infections caused by E. coli, according to the UK authors of new study.

The researchers found antibiotic resistance in children’s E. coli was high when commonly prescribed antibiotics were used and may persist for up to three months after treatment.

“Our study shows that antibiotic resistance to this common bacteria found in children is high”

Ashley Bryce

They noted that children were frequent consumers of antibiotics worldwide and such routine use has been shown to increase the probability of resistance in adults with urinary tract infections.

Despite this, they said that little was previously known about the prevalence of bacterial resistance in children or the most important risk factors.

The new study, led by the University of Bristol and Imperial College London, involved secondary analysis of data from 824 children under five years old consulting in primary care for an acute illness.

The children had previously been recruited to the Diagnosis of Urinary Tract infection in Young children (DUTY) study, which aimed to improve the diagnosis of urinary tract infections in children.

Public Health England

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Escherichia coli bacteria cells (E. coli)

The researchers investigated the prevalence of antibiotic resistance in E. coli, which is responsible for over 80% of all urinary tract infections (UTIs) in pre-school children. They also measured risk factors associated with resistant urinary E. coli, including previous antibiotic exposure.

They found a high prevalence of antibiotic resistance in urinary E. coli against several commonly prescribed antibiotics including amoxicillin, trimethoprim and co-amoxiclav.

In addition, almost a third of all E. coli were found to be multidrug resistant, said the researchers. There was also an association found between exposure to antibiotics in the previous three months and increased likelihood of a resistant urinary E. coli.

“Prevalence of resistance in children’s pathogenic and contaminant urinary E. coli was high for several commonly prescribed primary care antibiotics, namely amoxicillin, co-amoxiclav and trimethoprim; no isolates were resistant to nitrofurantoin,” said the researchers.

“High-level resistance could render such antibiotics ineffective as first-line treatments, and as a result require prescribing guidelines to be updated to reflect local resistance patterns,” they stated in the Journal of Antimicrobial Chemotherapy.

“It may be that these antibiotics, particularly amoxicillin, should no longer be recommended for use as a first-line treatment for UTI in the UK,” suggested the authors of the study, which was funded by the National Institute for Health Research School for Primary Care Research.

“Future research must prioritise increasing our understanding of antibiotic resistance in bacteria that commonly cause infections”

Céire Costello

Lead author Dr Ashley Bryce, from Bristol University, said: “Our study shows that antibiotic resistance to this common bacteria found in children is high, especially when antibiotics have previously been recently prescribed.

“Frequent exposure to antibiotics can disrupt the normal balance of bacteria within the urinary tract and gut, which can lead to increased risk of bacterial infection,” she said.

Primary care clinicians should, therefore, consider the “impact and necessity” of further antibiotic treatment before prescribing, highlighted Dr Bryce.

Fellow author Dr Céire Costelloe from Imperial College London, said: “Future research must prioritise increasing our understanding of antibiotic resistance in bacteria that commonly cause infections, so that prescribing guidelines can be updated to improve patient outcomes.”

The study follows a previous systematic review by the same team, which was published in the British Medical Journal in 2016, that explored the global prevalence of antibiotic resistance in children’s urinary tract infection caused by E. coli.

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