Children Receive a Disproportionate Share of Antibiotic Treatment Interview with:
Ashley Bryce, NIHR PhD student
Centre for Academic Primary Care, University of Bristol (first author)
Dr Céire Costelloe
NIHR Health Protection Research Unit in Healthcare associated infections and AMR, Imperial College London (senior author) What is the background for this study?

Response: Antimicrobial resistance is an internationally recognised threat to health. Previous antibiotic use has been shown to be a risk factor for antimicrobial resistance in adults.

The contribution of primary healthcare is particularly important as this is where almost 80% of all antibiotics used within the health service are prescribed. Children receive a lot of primary healthcare services and, as such, receive a disproportionately high number of antibiotics compared with middle aged populations.

Despite this, little research has been published describing the prevalence of bacterial resistance in children or the risk factors of importance in this group. What are the main findings?

Response: Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment. What should clinicians and patients take away from your report?

Response: Primary care clinicians should consider the impact of any antibiotic use on subsequent antimicrobial resistance and avoid their unnecessary use by following local and national guidance whenever possible. When antibiotic treatment is needed, our findings suggest that clinicians should consider a child’s individual antibiotic use in the past six months when selecting treatment.

GPs and parents of children may wish to consider the evidence presented in our study when discussing the benefits and risks of prescribing and consuming antibiotics. What recommendations do you have for future research as a result of this study?

Response: Prospective and unbiased resistance surveillance of uncomplicated uropathogens at the local practice levels is critical for informing empirical antimicrobial decisions and to ensure prompt and appropriate treatment for children with UTI. Future studies should consider using incident data to measure associations between resistance and time since exposure to antibiotics in children. Is there anything else you would like to add?

Response: Bacterial infections resistant to antibiotics can limit the availability of effective treatment options, rendering some commonly encountered bacterial infections difficult to treat, including those of the urinary tract. Antibiotic resistant infections are also twice as likely to be associated with greater morbidity and mortality and are associated with increased healthcare costs. Thank you for your contribution to the community.


Bryce, A, Hay, A, Lane, IF, Thornton, H, Wootton, M & Costelloe, C, 2016, ‘Global antibiotic resistance prevalence in paediatric Escherichia coli urinary tract infections and association with routine use of primary care antibiotics: a systematic review and meta-analysis’. BMJ.

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Ashley Bryce and Dr Céire Costelloe (2016). Children Receive a Disproportionate Share of Antibiotic Treatment

Last Updated on March 14, 2016 by Marie Benz MD FAAD