Resistance decay in individuals after antibiotic exposure in primary care: A systematic review and meta-analysis

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Abstract

BACKGROUND: Antibiotic resistance is an urgent global problem, but reversibility is poorly understood. We examined the development and decay of bacterial resistance in community patients after antibiotic use.

METHODS: This was a systematic review and meta-analysis. PubMed, EMBASE and CENTRAL (from inception to May 2017) were searched, with forward and backward citation searches of the identified studies. We contacted authors whose data were unclear, and of abstract-only reports, for further information. We considered controlled or times-series studies of patients in the community who were given antibiotics and where the subsequent prevalence of resistant bacteria was measured. Two authors extracted risk of bias and data. The meta-analysis used a fixed-effects model.

RESULTS: Of 24,492 articles screened, five controlled and 20 time-series studies (total 16,353 children and 1461 adults) were eligible. Resistance in Streptococcus pneumoniae initially increased fourfold after penicillin-class antibiotic exposure [odds ratio (OR) 4.2, 95% confidence interval (CI) 3.5-5.4], but this fell after 1 month (OR 1.7, 95% CI 1.3-2.1). After cephalosporin-class antibiotics, resistance increased (OR 2.2, 95%CI 1.7-2.9); and fell to (OR 1.6, 95% CI 1.2-2.3) at 1 month. After macrolide-class antibiotics, resistance increased (OR 3.8, 95% CI 1.9-7.6) and persisted for 1 month (OR 5.2, 95% CI 2.6-10.3) and 3 months (OR 8.1, 95% CI 4.6-14.2, from controlled studies and OR 2.3, 95% CI 0.6-9.4, from time-series studies). Resistance in Haemophilus influenzae after penicillins was not significantly increased (OR 1.3, 95% CI 0.9-1.9) initially but was at 1 month (OR 3.4, 95% CI 1.5-7.6), falling after 3 months (OR 1.0, 95% CI 0.5-2.2). Data were sparse for cephalosporins and macrolides. Resistance in Enterobacter increased post-exposure (OR 3.2, 95% CI 0.9-10.8, from controlled studies and OR 7.1, 95% CI 4.2-12, from time-series studies], but was lower after 1 month (OR 1.8, 95% CI 0.9-3.6).

CONCLUSIONS: Resistance generally increased soon after antibiotic use. For some antibiotic classes and bacteria, it partially diminished after 1 and 3 months, but longer-term data are lacking and urgently needed.

TRIAL REGISTRATION: PROSPERO CRD42015025499 .

Original languageEnglish
Article number126
Pages (from-to)126
JournalBMC Medicine
Volume16
Issue number1
DOIs
Publication statusPublished - 7 Aug 2018

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Meta-Analysis
Primary Health Care
Odds Ratio
Confidence Intervals
Anti-Bacterial Agents
Microbial Drug Resistance
Macrolides
Cephalosporins
Penicillins
Accidental Falls
Bacteria
Enterobacter
Haemophilus influenzae
Streptococcus pneumoniae
PubMed

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@article{02ac456e32f2490b9f3063836853769c,
title = "Resistance decay in individuals after antibiotic exposure in primary care: A systematic review and meta-analysis",
abstract = "BACKGROUND: Antibiotic resistance is an urgent global problem, but reversibility is poorly understood. We examined the development and decay of bacterial resistance in community patients after antibiotic use.METHODS: This was a systematic review and meta-analysis. PubMed, EMBASE and CENTRAL (from inception to May 2017) were searched, with forward and backward citation searches of the identified studies. We contacted authors whose data were unclear, and of abstract-only reports, for further information. We considered controlled or times-series studies of patients in the community who were given antibiotics and where the subsequent prevalence of resistant bacteria was measured. Two authors extracted risk of bias and data. The meta-analysis used a fixed-effects model.RESULTS: Of 24,492 articles screened, five controlled and 20 time-series studies (total 16,353 children and 1461 adults) were eligible. Resistance in Streptococcus pneumoniae initially increased fourfold after penicillin-class antibiotic exposure [odds ratio (OR) 4.2, 95{\%} confidence interval (CI) 3.5-5.4], but this fell after 1 month (OR 1.7, 95{\%} CI 1.3-2.1). After cephalosporin-class antibiotics, resistance increased (OR 2.2, 95{\%}CI 1.7-2.9); and fell to (OR 1.6, 95{\%} CI 1.2-2.3) at 1 month. After macrolide-class antibiotics, resistance increased (OR 3.8, 95{\%} CI 1.9-7.6) and persisted for 1 month (OR 5.2, 95{\%} CI 2.6-10.3) and 3 months (OR 8.1, 95{\%} CI 4.6-14.2, from controlled studies and OR 2.3, 95{\%} CI 0.6-9.4, from time-series studies). Resistance in Haemophilus influenzae after penicillins was not significantly increased (OR 1.3, 95{\%} CI 0.9-1.9) initially but was at 1 month (OR 3.4, 95{\%} CI 1.5-7.6), falling after 3 months (OR 1.0, 95{\%} CI 0.5-2.2). Data were sparse for cephalosporins and macrolides. Resistance in Enterobacter increased post-exposure (OR 3.2, 95{\%} CI 0.9-10.8, from controlled studies and OR 7.1, 95{\%} CI 4.2-12, from time-series studies], but was lower after 1 month (OR 1.8, 95{\%} CI 0.9-3.6).CONCLUSIONS: Resistance generally increased soon after antibiotic use. For some antibiotic classes and bacteria, it partially diminished after 1 and 3 months, but longer-term data are lacking and urgently needed.TRIAL REGISTRATION: PROSPERO CRD42015025499 .",
author = "Mina Bakhit and Tammy Hoffmann and Scott, {Anna Mae} and Elaine Beller and John Rathbone and {Del Mar}, Chris",
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Resistance decay in individuals after antibiotic exposure in primary care : A systematic review and meta-analysis. / Bakhit, Mina; Hoffmann, Tammy; Scott, Anna Mae; Beller, Elaine; Rathbone, John; Del Mar, Chris.

In: BMC Medicine, Vol. 16, No. 1, 126, 07.08.2018, p. 126.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Resistance decay in individuals after antibiotic exposure in primary care

T2 - A systematic review and meta-analysis

AU - Bakhit, Mina

AU - Hoffmann, Tammy

AU - Scott, Anna Mae

AU - Beller, Elaine

AU - Rathbone, John

AU - Del Mar, Chris

PY - 2018/8/7

Y1 - 2018/8/7

N2 - BACKGROUND: Antibiotic resistance is an urgent global problem, but reversibility is poorly understood. We examined the development and decay of bacterial resistance in community patients after antibiotic use.METHODS: This was a systematic review and meta-analysis. PubMed, EMBASE and CENTRAL (from inception to May 2017) were searched, with forward and backward citation searches of the identified studies. We contacted authors whose data were unclear, and of abstract-only reports, for further information. We considered controlled or times-series studies of patients in the community who were given antibiotics and where the subsequent prevalence of resistant bacteria was measured. Two authors extracted risk of bias and data. The meta-analysis used a fixed-effects model.RESULTS: Of 24,492 articles screened, five controlled and 20 time-series studies (total 16,353 children and 1461 adults) were eligible. Resistance in Streptococcus pneumoniae initially increased fourfold after penicillin-class antibiotic exposure [odds ratio (OR) 4.2, 95% confidence interval (CI) 3.5-5.4], but this fell after 1 month (OR 1.7, 95% CI 1.3-2.1). After cephalosporin-class antibiotics, resistance increased (OR 2.2, 95%CI 1.7-2.9); and fell to (OR 1.6, 95% CI 1.2-2.3) at 1 month. After macrolide-class antibiotics, resistance increased (OR 3.8, 95% CI 1.9-7.6) and persisted for 1 month (OR 5.2, 95% CI 2.6-10.3) and 3 months (OR 8.1, 95% CI 4.6-14.2, from controlled studies and OR 2.3, 95% CI 0.6-9.4, from time-series studies). Resistance in Haemophilus influenzae after penicillins was not significantly increased (OR 1.3, 95% CI 0.9-1.9) initially but was at 1 month (OR 3.4, 95% CI 1.5-7.6), falling after 3 months (OR 1.0, 95% CI 0.5-2.2). Data were sparse for cephalosporins and macrolides. Resistance in Enterobacter increased post-exposure (OR 3.2, 95% CI 0.9-10.8, from controlled studies and OR 7.1, 95% CI 4.2-12, from time-series studies], but was lower after 1 month (OR 1.8, 95% CI 0.9-3.6).CONCLUSIONS: Resistance generally increased soon after antibiotic use. For some antibiotic classes and bacteria, it partially diminished after 1 and 3 months, but longer-term data are lacking and urgently needed.TRIAL REGISTRATION: PROSPERO CRD42015025499 .

AB - BACKGROUND: Antibiotic resistance is an urgent global problem, but reversibility is poorly understood. We examined the development and decay of bacterial resistance in community patients after antibiotic use.METHODS: This was a systematic review and meta-analysis. PubMed, EMBASE and CENTRAL (from inception to May 2017) were searched, with forward and backward citation searches of the identified studies. We contacted authors whose data were unclear, and of abstract-only reports, for further information. We considered controlled or times-series studies of patients in the community who were given antibiotics and where the subsequent prevalence of resistant bacteria was measured. Two authors extracted risk of bias and data. The meta-analysis used a fixed-effects model.RESULTS: Of 24,492 articles screened, five controlled and 20 time-series studies (total 16,353 children and 1461 adults) were eligible. Resistance in Streptococcus pneumoniae initially increased fourfold after penicillin-class antibiotic exposure [odds ratio (OR) 4.2, 95% confidence interval (CI) 3.5-5.4], but this fell after 1 month (OR 1.7, 95% CI 1.3-2.1). After cephalosporin-class antibiotics, resistance increased (OR 2.2, 95%CI 1.7-2.9); and fell to (OR 1.6, 95% CI 1.2-2.3) at 1 month. After macrolide-class antibiotics, resistance increased (OR 3.8, 95% CI 1.9-7.6) and persisted for 1 month (OR 5.2, 95% CI 2.6-10.3) and 3 months (OR 8.1, 95% CI 4.6-14.2, from controlled studies and OR 2.3, 95% CI 0.6-9.4, from time-series studies). Resistance in Haemophilus influenzae after penicillins was not significantly increased (OR 1.3, 95% CI 0.9-1.9) initially but was at 1 month (OR 3.4, 95% CI 1.5-7.6), falling after 3 months (OR 1.0, 95% CI 0.5-2.2). Data were sparse for cephalosporins and macrolides. Resistance in Enterobacter increased post-exposure (OR 3.2, 95% CI 0.9-10.8, from controlled studies and OR 7.1, 95% CI 4.2-12, from time-series studies], but was lower after 1 month (OR 1.8, 95% CI 0.9-3.6).CONCLUSIONS: Resistance generally increased soon after antibiotic use. For some antibiotic classes and bacteria, it partially diminished after 1 and 3 months, but longer-term data are lacking and urgently needed.TRIAL REGISTRATION: PROSPERO CRD42015025499 .

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U2 - 10.1186/s12916-018-1109-4

DO - 10.1186/s12916-018-1109-4

M3 - Article

VL - 16

SP - 126

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

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