Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study
Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study
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DOI：
10.1136/bmj.39274.647465.be
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发表时间：
2007-09-01
影响因子：
105.7
通讯作者：
Mant, David
中科院分区：
文献类型：
--
作者：
Chung, Angela;Perera, Rafael;Mant, David
目的评估社区处方抗生素治疗急性呼吸道感染对单个儿童抗生素耐药菌患病率的影响。研究设计观察性队列研究，随访2周和12周。研究背景：牛津郡的一般做法。参与者：119名急性呼吸道感染儿童，其中71例接受β-内酰胺类抗生素治疗。主要结果指标抗生素耐药性通过几何平均最小抑菌浓度（MIC）评估对于氨苄青霉素和ICEHin 1056耐药元件的存在，在招募时，两周，结果在一般实践中给儿童处方阿莫西林是氨苄西林平均最低抑菌浓度的三倍多（9.2 μ g/ml v2.7 μ g/ml，P=0.005），两周后分离出具有ICEHin 1056同源物的嗜血杆菌分离株的风险加倍（67% v36%;相对风险1.9，95%置信区间1.2 - 2.9）。虽然这种增长是短暂的（到12周时，氨苄青霉素耐药性下降至接近基线），它是在从招募时35%的嗜血杆菌分离株儿童和83%的（76%至89%）结论：在初级保健中处方阿莫西林的短期效果在个别儿童中是暂时的，但足以维持一个长期的疗效。人群中的高水平抗生素耐药性。
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 beta 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 Hoemophilus 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 mu g/ml v 2.7 mu g/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 ampicilin 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.