High levels of antibiotic resistance in children could render some of the most common treatments for urinary tract infections ineffective, suggests a study by UK researchers.
The study – published in the British Medical Journal – is the latest to raise questions about current worldwide approaches to treating urinary tract infections in children in primary care.
“Their findings confront long-established patterns of practice”
Researchers from the University of Bristol and Imperial College London reviewed the results of 58 studies looking at levels of antibiotic resistance in urinary infections caused by E coli – the bacteria responsible for more than 80% of urinary tract infections in children.
The studies spanned 26 different countries and involved more than 77,000 E coli samples.
The research team found worryingly high levels of resistance to some of the most commonly prescribed antibiotics used to treat this type of infection.
They compared results for countries in the OECD – Organisation for Economic Co-operation and Development – and those outside it because of differences in the way antibiotics are used by these two groups.
In OECD countries, including the UK, half of all samples were resistant to ampicillin – also known as amoxicillin, a third were resistant to co-trimoxazole and a quarter to trimethoprim.
Resistance was substantially greater in non-OECD countries, where antibiotics can frequently be bought over the counter.
The researchers also set out to track whether previous exposure to an antibiotic was linked to subsequent resistance in individual children.
They found there was an increased risk of E coli resistance to a particular antibiotic for up to six months after treatment.
In an editorial in the BMJ, Professor Grant Russell, from Monash University in Melbourne, Australia, said the study raised key questions for primary care clinicians.
The “remarkable” variation in antibiotic resistance between different countries meant it was important for doctors and nurses to understand the patterns in their own and other nations, he said.
Warning over paediatric antibiotic resistance
“The high prevalence of resistance in Middle Eastern countries, for example, is a particular challenge for management of refugee children from the current Syrian conflict,” he noted.
Meanwhile, primary care professionals may need to get used to taking an “antibiotic history” before prescribing for common bacterial infections, he said.
Overall, he said the researchers provided “compelling evidence of the need to reconsider current approaches to community based management of paediatric urinary tract infection”.
“Their findings confront long-established patterns of practice and are inextricably linked to the emerging global problem of antimicrobial resistance,” he warned.