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Huge rise in MRSA linked with childhood antibiotics

By Lilian Anekwe

A dramatic rise in the prescription of antibiotics for childhood skin infections has been linked with a surge in GP consultations and hospital admissions for serious MRSA infections.

An analysis of UK primary care data found GP prescribing of anti-staphylococcal drugs for skin conditions has soared by 64% in ten years.

Over the same period GP consultations for skin infections rose by 19% and hospital admissions for Staphylococcal aureus increased by 49% - a relationship the UK authors said was unlikely to have arisen ‘by chance'.

Researchers analysed data drawn from a database of 500 GP who contribute clinical data on more than a million patients between 1997 and 2006, and counted prescriptions for all oral and topical antibacterial drugs prescribed for skin infections.

Prescriptions for oral flucloxacillin were taken as a proxy measure for ‘unresolved S. aureus skin infections'.

GP consultation rates for all skin conditions in children rose between 1997 and 2006, from 128.5 per 1,000 child-years to 152.9 per 1,000 child-years – a 19% increase. At time same time there was a 64% increase in prescribing rates for flucloxacillin, from 17.8 to 29.1 per 1,000 child-years.

But consultation rates for atopic eczema decreased during this time, which researchers argued proved the rise was not due to severe complications of other skin conditions but for more invasive infections.

Over the same period prescribing of all other antibacterials in children decreased by 11%, from 541.4 to 484.3 per 1,000 child-years, while prescribing rates for amoxicillin, clavulanic acid and fusidic acid changed by only 2%. Flucloxacillin was the most commonly prescribed antibacterial drug, representing 37% of all prescriptions.

Lead researcher Dr Sonia Saxena, consultant senior lecturer in primary care and a GP in Putney, London, said: ‘The increasing incidence of childhood skin infections and prescribing of the major antistaphylococcal drug flucloxacillin, coupled with concurrent increases in childhood hospital admissions for skin, bone and joint infections caused by S. aureus, suggests an increase in community-onset S.aureus disease in England over the past ten years.'

She told Pulse: ‘I think that this is a true trend. The implications are that that GPs should be vigilant that Staph aureus is potentially serious and does have serious complications. They should not be prescribing topical agents or recommending over the counter topicals like Fucidin. These are ineffective and likely to make the condition worse.

‘The rise in flucloxacillin prescribing, coupled with the prescribing of drugs that are not appropriate, means infections persist and become more serious and could be spread in the community.'

Dr Tim Mitchell, a GP with an interest in dermatology in Bristol, said: ‘I think flucloxacillin is a good antibiotic. The man problem with skin infections like impetigo is that there might be a resistance problem with Fucidin, and other agent may not be as a effective. Flucloxacillin has always been put forward as a good option. We don't have a really good alternative, which is a problem.'

The study was published in the March issue of Emerging Infectious Diseases.

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