Routine GP prescribing of antibiotics to treat urinary tract infections (UTIs) in children and young people are contributing to antimicrobial resistance and should be reviewed, a study has concluded.
The researchers from the University of Bristol said their finding, which was based on an international meta-analysis of 58 previous studies of antibiotic resistance and UTIs caused by E.coli, means that ’as a result, many guidelines, such as those published by NICE, might need updating’.
The study found that countries within the Organisation for Economic Cooperation and Developement (OECD), such as the UK, had lower levels of resistance than less-developed nations, but that resistance was still high to many first-line treatments including ampicillin, trimethoprim and co-amoxiclav.
It further found that children who received previous prescriptions for antibiotics in primary care were more than 13 times more likely to have resistance to antibiotics, which could last up to six months after treatment, and that ‘ampicillin, co-trimoxazole, and trimethoprim are no longer suitable first-line treatment options for urinary tract infection in many OECD countries’.
Ampicillin had the highest resistance globally, with prevalence of resistance at 53.4% in developed countries and 79.8% in developing countries (Ghana and Nigeria both have a prevalence of resistance of 100%). Meanwhile, co-trimoxazole and trimethoprim resistance was 30% and 23.6% respectively in developed countries.
The paper, published in the BMJ, said: ‘Prevalence of resistance to commonly prescribed primary care antibiotics in E.coli urinary tract infections in children is high, particularly in non-OECD countries, where one possible explanation is availability of antibiotics over the counter. This could render some drugs ineffective as first-line treatments for urinary tract infection.
‘Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after antibiotic prescription.’
The researchers concluded their study ‘supports other evidence for the continued availability of nitrofurantoin [a synthetic compound with antibacterial properties] as an effective treatment for uncomplicated urinary tract infections in primary care’.