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EDITORIALS: Chris Del Mar Prescribing antibiotics in primary care BMJ 2007; 335: 407-408 [Full text]

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Antimicrobial use for children and resistance in the comminuty

Vilhjalmur Arason, Hafnarfjordur   (7 September 2007)

Antimicrobial use for children and resistance in the comminuty 7 September 2007
Vilhjalmur Arason, GP Healthcenter Fjordur, Hafnarfjordur Send response to journal: Re: Antimicrobial use for children and resistance in the comminuty	Dear BMJ editors Now 11 years from published article in your journal 1996; Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study BMJ 313:387-91 and after finishing the 10 years follow up studies afterward 1998 and 2003, published in 4 articles in three other journals I want to give BMJ readers opportunity to have overview or insight in the whole study and final conclusions published in my PhD thesis; Use of Antimicrobials and Carriage of Penicillin-Resisant Pneumococci in Children repeaded cross- sectional studies covering 10 years (2006) http://www.hirsla.lsh.is/lsh/bitstream/2336/11250/3/use_of_arason_ot_1.pdf In contemporary Western societies, infections from the upper respiratory tract, especially acute otitis media in children are the most common reasons for visiting a doctor in primary health care. The prevalence of penicillin-resistant Streptococcus pneumoniae is highest in countries with relatively unrestricted antimicrobial use. It has been low in northern Europe except Iceland where strong association has been shown with carriage of these penicillin-resistant pneomococci among children. An association has also been observed on the community level between the prescription of oral antimicrobials, changes in prescriptions habits among the GPs in some areas, specifically for acute otitis media, and the cumulative prevalence of tympanostomy tube placements. Parents' expectations of antimicrobial prescriptions are also associated with the doctor's handling of upper respiratory tract infections. The possibility of a causative, positive correlation between antimicrobial drug (over)use for acute otitis media, future episodes of acute otitis media and tympanostomy tube placement later warrants further investigation. The most interesting topic for the world is though the interaction between selective antimicrobial pressure and clonal dynamics of PNSP Spain6B-2 in our community-studies in Iceland covering ten years. Also comparisons of individual linked data with group level data in relation to antibiotic use and resistance that could be obscured by only group level ecological studies. With kind regards Vilhjálmur Ari Arason PhD MD Healthcenter Fjordur, Hafnarfirði Iceland. Competing interests: None declared