Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study

doi:10.1136/bmj.39274.647465.BE

BMJ 2007;335:429 (1 September), doi:10.1136/bmj.39274.647465.BE (published 26 July 2007)

Research

Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study

Angela Chung, clinical research fellow¹, Rafael Perera, senior research fellow in statistics¹, Angela B Brueggemann, infectious disease lecturer², Abdel E Elamin, research student³, Anthony Harnden, university lecturer¹, Richard Mayon-White, consultant epidemiologist¹, Susan Smith, research group coordinator¹, Derrick W Crook, consultant in infectious disease and microbiology³, David Mant, professor¹

¹ Department of Primary Health Care, NIHR School of Primary Care Research, University of Oxford, Oxford OX3 7LF, ² Department of Zoology, University of Oxford, Oxford OX1 3PS, ³ Nuffield Department of Clinical and Laboratory Science, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU

Correspondence to: D Mant david.mant{at}dphpc.ox.ac.uk

Objective To assess the effect of community prescribing of anantibiotic for acute respiratory infection on the prevalenceof antibiotic resistant bacteria in an individual child.

Study design Observational cohort study with follow-up at twoand 12 weeks.

Setting General practices in Oxfordshire.

Participants 119 children with acute respiratory tract infection,of whom 71 received a $beta$ lactam antibiotic.

Main outcome measures Antibiotic resistance was assessed bythe geometric mean minimum inhibitory concentration (MIC) forampicillin and presence of the ICEHin1056 resistance elementin up to four isolates of Haemophilus species recovered fromthroat swabs at recruitment, two weeks, and 12 weeks.

Results Prescribing amoxicillin to a child in general practicemore than triples the mean minimum inhibitory concentrationfor ampicillin (9.2 µg/ml v 2.7 µg/ml, P=0.005)and doubles the risk of isolation of Haemophilus isolates possessinghomologues of ICEHin1056 (67% v 36%; relative risk 1.9, 95%confidence interval 1.2 to 2.9) two weeks later. Although thisincrease is transient (by 12 weeks ampicillin resistance hadfallen close to baseline), it is in the context of recoveryof the element from 35% of children with Haemophilus isolatesat recruitment and from 83% (76% to 89%) at some point in thestudy.

Conclusion The short term effect of amoxicillin prescribed inprimary care is transitory in the individual child but sufficientto sustain a high level of antibiotic resistance in the population.

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This article has been cited by other articles:

Coenen, S., Goossens, H. (2007). Antibiotics for respiratory tract infections in primary care. BMJ 335: 946-947 [Full text]
(2007). Transient Antibiotic Resistance After a Single Course of Amoxicillin. JWatch Emergency Med. 2007: 4-4 [Full text]
Mar, C. D. (2007). Prescribing antibiotics in primary care. BMJ 335: 407-408 [Full text]

Rapid Responses:

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Darwin, Lamarck, or Intelligent Design ?: L Sam Lewis
bmj.com, 2 Aug 2007 [Full text]
Re: Effect of antibiotic prescribing: David Mitchell
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Leave Primary care alone: Andrew C Barnes
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