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

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

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

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

Setting General practices in Oxfordshire.

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

Main outcome measures Antibiotic resistance was assessed by the geometric mean minimum inhibitory concentration (MIC) for ampicillin and presence of the ICEHin1056 resistance element in up to four isolates of Haemophilus species recovered from throat swabs at recruitment, two weeks, and 12 weeks.

Results Prescribing amoxicillin to a child in general practice more than triples the mean minimum inhibitory concentration for ampicillin (9.2 µg/ml v 2.7 µg/ml, P=0.005) and doubles the risk of isolation of Haemophilus isolates possessing homologues of ICEHin1056 (67% v 36%; relative risk 1.9, 95% confidence interval 1.2 to 2.9) two weeks later. Although this increase is transient (by 12 weeks ampicillin resistance had fallen close to baseline), it is in the context of recovery of the element from 35% of children with Haemophilus isolates at recruitment and from 83% (76% to 89%) at some point in the study.

Conclusion The short term effect of amoxicillin prescribed in primary care is transitory in the individual child but sufficient to 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 ?

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bmj.com, 2 Aug 2007 [Full text]

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