Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study

Nasrin, Dilruba; Collignon, Peter; Roberts, Leslee; Wilson, Elena Alexandrovna; Pilotto, Louis; Douglas, Robert M.

doi:10.1136/bmj.324.7328.28

Cited by 130 publications

(76 citation statements)

References 13 publications

(10 reference statements)

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“…34 The immediate hazards of antibiotic use are increased side effects and costs of therapy. 24,35 Recent antibiotic use also increases the likelihood that resistant strains will develop, 9,[36][37][38] and antibiotic resistance has been reported in the absence of previous antibiotic prescriptions, when community use of antibiotics is high. 9,37 Resistance patterns have mirrored temporal and regional patterns of BS antibiotic use.…”

Section: Discussionmentioning

confidence: 99%

Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children

Kozyrskyj

Carrie²,

Mazowita³

et al. 2004

Canadian Medical Association Journal

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Background: Decreases in antibiotic use were widely reported in the 1990s. This study was undertaken to determine trends in the use of antibiotics from fiscal year (FY) 1995 (April 1995 to March 1996 to FY 2001 in a complete population of Manitoba children. Methods: Using Manitoba's health care databases, we determined annual population-based rates of antibiotic prescription among children by antibiotic class (narrow-spectrum and broaderspectrum antibiotics), age group, physician diagnosis (e.g., otitis media or bronchitis) and neighbourhood income in urban areas (derived from the 1996 census). Antibiotic prescription rates were generated within a generalized linear model framework with general estimating equations, and differences between FY 2001 and FY 1995 were tested. Differences in antibiotic use over time were compared across antibiotic classes, age groups, diagnoses and income neighbourhoods. Results: The overall antibiotic prescription rate decreased by almost one-third, from 1.2 prescriptions per child in FY 1995 to 0.9 prescriptions in FY 2001. Total antibiotic use declined for all respiratory tract infections; decreases were greatest for the sulfonamides (decrease to less than one-third the FY 1995 rate) and narrow-spectrum macrolides (decrease to less than half the FY 1995 rate). In contrast, the FY 2001 rate for broader-spectrum macrolides was as much as 12.5 times the FY 1995 rate. Otitis media accounted for one-quarter of the use of the latter agents. Preschool children and low-income children received the greatest number of antibiotic prescriptions. Declines in antibiotic prescriptions were of a lesser magnitude for low-income children (for whom rates in FY 2001 were four-fifths the rates in FY 1995) than for higher-income children (for whom rates in FY 2001 were about two-thirds the rates in FY 1995). Interpretation: Overall, antibiotic use declined over the late 1990s in this population of Canadian children, but the increasing use of broader-spectrum macrolides and higher rates of antibiotic use among preschool and low-income children may have implications for antibiotic resistance.

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Section: Discussionmentioning

confidence: 99%

Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children

Kozyrskyj

Carrie²,

Mazowita³

et al. 2004

Canadian Medical Association Journal

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“…Worldwide, risk factors for the carriage of resistant S. pneumoniae have been well investigated in the last couple of decades [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] and those studies reported that the most influencing factor was the previous use of antibiotics. Unnecessary use of antibiotics had been thought to cause this emergence of antibiotic resistant S. pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

Non-Antibiotic Treatment for Pediatric Outpatients With Common Cold Inhibits the Emergence of Drug Resistant Pneumococci

Matsumoto

Takeyama

Hashimoto

et al. 2010

FJMS

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: The occurrence of drug resistant Streptococcus pneumoniae (S. pneumoniae) is very high in Japan. Unnecessary use of antibiotics had been thought to cause this problem but previous studies had not clearly showed that the decreasing rate of antibiotic use had been related to the reduction of the prevalence of resistant strains. In this study, we tried to prove that non -antibiotic treatment for common cold would reduce the antibiotic resistant S. pneumoniae in nasopharynx in children. Forty -five children with the common cold were randomly selected from pediatric patients who had taken antibiotics within the past three months. We collected nasopharyngeal swabs from all of the participants and once again after a period of 2 to 3 months without using any antibiotics. Twenty -four of these patients had the S. pneumoniae strains isolated. Then these strains were undergone a susceptibility test and drug -resistant gene detection. The susceptibility test reveled that patients with penicillin -resistant strains decreased from 17 to 7 (p<0.01). The test also reveled that the decreased number of patients had strains that were resistant to cefditren. The gene detection revealed that none of the patients acquired a higher resistance to penicillin. Our study suggests that the treatment without antibiotics reduces the drug -resistant S. pneumoniae. Controlled antibiotic use in children might prevent children from carrying the antibiotic resistant S. pneumoniae.

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“…[1][2][3][4][5] Although debated, several publications have suggested that decreasing antibiotic consumption could contribute to reducing the prevalence of antibiotic-resistant bacteria. [6][7][8][9] Strong evidence suggests that a substantial proportion of antibiotic prescriptions in general practice could be avoided. 10 Respiratory tract infections (RTIs) are the most common reason for antibiotic prescriptions in primary care.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of an educational seminar on antibiotic prescribing by GPs: a randomised controlled trial

Corvoisier

Renard²,

Roudot‐Thoraval³

et al. 2013

Br J Gen Pract

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BackgroundHigh levels of outpatient antibiotic use remain observed in many European countries. Several studies have shown a strong relationship between antibiotic use and bacterial resistance. AimTo assess the long-term effect of a standardised educational seminar on antibiotic prescriptions by GPs. Design and settingRandomised controlled trial of 171 GPs (of 203 initially randomised) in France. MethodGPs in the control group (n = 99) received no antibiotic prescription recommendation. Intervention group GPs (n = 72) attended an interactive seminar presenting evidencebased guidelines on antibiotic prescription for respiratory infections. The proportion of prescriptions containing an antibiotic in each group and related costs were compared to the baseline up to 30 months following the intervention. Data were obtained from the National Health Insurance System database. ResultsIn the intervention group, 4-6 months after the intervention, there was a significant decrease in the proportion of prescriptions containing an antibiotic from 15.2 ± 5.4% to 12.3 ± 5.8% (-2.8% [95% CI = -3.8 to -1.9], P<0.001). By contrast, an increase was observed in controls from 15.3 ± 6.0 to 16.4 ± 6.7% (+1.1% [95% CI = +0.4 to +1.8], P<0.01), resulting in a between-group difference of 3.93% ([95% CI = 2.75 to 5.11], P<0.001). The between-group difference was maintained 30 months after intervention (1.99% [95% CI = 0.56 to 3.42], P<0.01). Persistence of the intervention effect over the entire study period was confirmed in a hierarchical multivariate analysis. ConclusionThis randomised trial shows that a standardised and interactive educational seminar results in a long-term reduction in antibiotic prescribing and could justify a large-scale implementation of this intervention.

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Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study

Cited by 130 publications

References 13 publications

Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children

Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children

Non-Antibiotic Treatment for Pediatric Outpatients With Common Cold Inhibits the Emergence of Drug Resistant Pneumococci

Long-term effects of an educational seminar on antibiotic prescribing by GPs: a randomised controlled trial

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