Is antibiotic use associated with resistance in individual patients?

January 01, 0001

Is antibiotic use associated with resistance in individual patients?

Antibiotic resistance is a large and growing concern. These British authors performed a systematic review and meta-analysis examining whether antibiotics prescribed in primary care settings were associated with subsequent antibiotic resistance in the same patients. They used Medline, Embase and Cochrane searches.

The authors report: "The review included 24 studies, 22 involved patients with symptomatic infection and two involved healthy volunteers. Nineteen were observational studies (of which two were prospective) and five were randomised trials. In five studies of urinary tract bacteria (14 348 participants), the pooled odds ratio (OR) for resistance was 2.5 (within 2 months of antibiotic treatment and 1.33 within 12 months. In seven studies of respiratory tract bacteria (2605 participants), pooled ORs were 2.4 and 2.4 for the same periods, respectively. Studies reporting the quantity of antibiotic prescribed found that longer duration and multiple courses were associated with higher rates of resistance. Studies comparing the potential for different antibiotics to induce resistance showed no consistent effects. Only one prospective study reported changes in resistance over a long period- pooled ORs fell from 12.2 at 1 week to 6.1 at 1 month, 3.6 at 2 months, and 2.2 at 6 months."

The authors concluded: "Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic. The effect is greatest in the month immediately after treatment but may persist for up to 12 months. This effect not only increases the population carriage of organisms resistant to first line antibiotics, but also creates the conditions for increased use of second line antibiotics in the community."

This systematic review and meta-analysis suggests, given the possibility of resistance in at least the near term, recent antibiotic history may alter treatment plans.

For the full abstract, click here.

BMJ 340:c2096, 18 May 2010 © 2010 Costelloe et al.
Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta- analysis. Céire Costelloe, Chris Metcalfe, Andrew Lovering, David Mant, and Alastair D Hay. Correspondence to A Hay: [email protected]

Category: A. General/Unspecified. Keywords: antibiotic resistance, primary care, UTI, URI, individual patients, systematic review and meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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