Some antibiotics may be ineffective as first line treatments for pediatric urinary tract infections (UTI) caused by Escherichia coli, and the routine use of antibiotics in primary care can contribute to antimicrobial resistance in children, which can persist for up to 6 months after treatment. This according to a meta-analysis of 58 observational studies which examined 77,783 E coli isolates in urine in children and young people aged 0 to 17 years. Researchers found:

• In studies from Organisation for Economic Co-operation and Development (OECD) countries, pooled prevalence of resistance was 53.4% for ampicillin, 23.6% for trimethoprim, 8.2% for co-amoxiclav, and 2.1% for ciprofloxacin. Nitrofurantoin was the lowest at 1.3%.

• Resistance in studies in countries outside the OECD was significantly higher: 79.8% for ampicillin, 60.3% for co-amoxiclav, 26.8% for ciprofloxacin, and 17% for nitrofurantoin.

• Bacterial isolates from the UT from individual children who had received previous prescriptions for antibiotics in primary care were more likely to be resistant to antibiotics, and this increased risk could persist for up to 6 months (OR=13.23).

Citation: Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. [Published online ahead of print March 15, 2016]. BMJ. 2016;352:i939. doi:http://dx.doi.org/10.1136/bmj.i939.

Commentary: Antibiotic resistance is an important worldwide problem. It is clear that the more antibiotics are prescribed, the higher the rate of resistance among bacteria that need to be treated. The likely reason for the higher rates of resistance in non-OECD countries is that those countries often allow over-the-counter sales of antibiotics, so the antibiotics are often overused. An important finding in this study is the fact that antibiotic stewardship, which is the careful use of antibiotics, is also important not just to decrease general antibiotic resistance, but because it has an immediate effect for the individual patient. Use of antibiotics increases the prevalence of resistant organisms in a given individual for up to 6 months. —Neil Skolnik, MD