Document Detail


Trimethoprim prescription and subsequent resistance in childhood urinary infection: multilevel modelling analysis.
MedLine Citation:
PMID:  23540479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Antibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children.
AIM: To investigate the association between previous trimethoprim prescribing and resistance in urinary Escherichia coli (E. coli) isolates in children.
DESIGN AND SETTING: Retrospective, population cohort study in Tayside, Scotland.
METHOD: Multilevel modelling of linked microbiology and dispensed prescribing data for 1373 ≤16-year-olds with E. coli urinary isolates in 2004-2009, examining the association between prior trimethoprim prescription and subsequent trimethoprim resistance in people with urinary E. coli isolates.
RESULTS: Trimethoprim resistance was common (26.6%, 95% confidence interval [CI] = 24.6 to 28.6). Previous trimethoprim prescription was associated with subsequent culture of trimethoprim-resistant E. coli, with more recent prescription being more strongly associated with resistance. After adjusting for the number of previous E. coli isolates and sample year, trimethoprim prescribing in the previous 84 days remained significantly associated with culturing trimethoprim-resistant E. coli (adjusted OR 4.71, 95% CI = 1.83 to 12.16 for the previous 15-28 days versus never prescribed; adjusted OR 3.16, 95% CI = 1.63 to 6.13 for the previous 29-84 days); however, associations were not statistically significant for longer periods since prior exposure.
CONCLUSION: Trimethoprim prescription has implications for future resistance in individual children, as well as at population level. Clinicians must ensure appropriateness of treatment choice and duration, and alternative antibiotics should be considered for childhood urinary tract infections if trimethoprim has been prescribed in the preceding 3 months.
Authors:
Mary A Duffy; Virginia Hernandez-Santiago; Gillian Orange; Peter G Davey; Bruce Guthrie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  63     ISSN:  1478-5242     ISO Abbreviation:  Br J Gen Pract     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2014-01-21     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  e238-43     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age of Onset
Anti-Infective Agents, Urinary / therapeutic use*
Child
Child, Preschool
Escherichia coli / drug effects*,  isolation & purification
Escherichia coli Infections / drug therapy*,  epidemiology,  microbiology
Female
Humans
Infant
Infant, Newborn
Male
Microbial Sensitivity Tests
Population Surveillance
Retrospective Studies
Scotland / epidemiology
Trimethoprim / therapeutic use*
Trimethoprim Resistance*
Urinary Tract Infections / drug therapy*,  epidemiology,  microbiology
Chemical
Reg. No./Substance:
0/Anti-Infective Agents, Urinary; AN164J8Y0X/Trimethoprim
Comments/Corrections

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