Penicillin resistance increased in children after beta lactam use

NEW YORK (Reuters Health) – Young children who receive beta lactam antibiotics are at increased risk of developing penicillin resistant pneumococci. But new prescribing policies that reduce beta lactam use could quickly reverse this trend, Australian researchers report in the January 5th issue of the British Medical Journal.

Dr. Robert M. Douglas, from the Australian National University, Canberra, and colleagues collected data for 461 children under 4 years of age. During 25 months of observation, parents documented their child's use of drugs, respiratory symptoms, and physician visits. The researchers also tested pneumococci, cultured from nasal swabs, for penicillin resistance.

From four swab collections, the researchers identified 631 positive pneumococcal isolates. They further examined 456 isolates collected from children with drug treatment records that were at least 75% complete in the previous 6 months. Of these isolates, Dr. Douglas's team found that 14.9% were penicillin resistant. Penicillin resistance was significantly associated with beta lactam use in the 2 months before the swabs were collected (odds ratio 2.03, p = 0.01), they note.

This link remained strong in children who received only penicillin or only cephalosporin, the Australian researchers add. The odds ratio of carrying a penicillin-resistant isolate was 4.67 among those children who received both types of antibiotics in the 2 months before swabs were collected.

For each additional day of beta lactam use in the 6 months before swabs were collected, the likelihood of a child carrying penicillin resistant pneumococcus increased 4%, the investigators add.

Dr. Douglas and colleagues believe that "a substantial reduction of beta lactam use in preschool children could quickly result in reduced carriage of penicillin resistant pneumococci…If these drugs are to retain their clinical usefulness, new prescribing policies are needed in community practice."

BMJ 2002;324:28-30.

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