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

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Term Occurence Count Dictionary
amoxicillin 2 infectiousdiseasesdrugs
azithromycin 1 infectiousdiseasesdrugs
clindamycin 2 infectiousdiseasesdrugs
erythromycin 1 infectiousdiseasesdrugs
pneumonia 10 infectiousdiseases
sulfamethoxazole 3 infectiousdiseasesdrugs
trimethoprim 5 infectiousdiseasesdrugs

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Select Drug Character Offset Drug Term Instance
amoxicillin 19673 RCT [[28]] investigated reported resistance in isolates (rather than individuals) after exposure to amoxicillin and its data are analysed separately. It found that the changes in resistance following amoxicillin
amoxicillin 19773 amoxicillin and its data are analysed separately. It found that the changes in resistance following amoxicillin exposure were short-lived, returning to normal by 1 month after the end of treatment (Fig. 3).S. pneumoniae
azithromycin 24616 different antibiotic than the exposure antibiotic (co-resistance). In respiratory isolates, 3 months after azithromycin exposure, the OR of isolating clindamycin-resistant S. pneumoniae (OR 4, 95% CI 1.6–10.1) and erythromycin-resistant
clindamycin 24046 0.9–3.6) at 1 month (Fig. 5).One RCT [[43]] investigated the consequences of a 1-week course of clindamycin on Bacteroides species using isolates rather than participants as the unit of analysis. It reported
clindamycin 24659 (co-resistance). In respiratory isolates, 3 months after azithromycin exposure, the OR of isolating clindamycin -resistant S. pneumoniae (OR 4, 95% CI 1.6–10.1) and erythromycin-resistant S. pneumoniae (OR 2.1,
erythromycin 24725 azithromycin exposure, the OR of isolating clindamycin-resistant S. pneumoniae (OR 4, 95% CI 1.6–10.1) and erythromycin -resistant S. pneumoniae (OR 2.1, 95% CI 1.1–3.9) was significantly higher between exposed and unexposed
sulfamethoxazole 18304 from the end of antibiotic exposure. -ve, negative, CI confidence interval, df degrees of freedom, SMX sulfamethoxazole , TMP trimethoprimResistance in respiratory tract bacteriaBacteria were isolated from the respiratory
sulfamethoxazole 23644 resistant Gram-negative bacteria was 3.2 (95% CI 0.9–10.8; Fig. 5).Trimethoprim and trimethoprim- sulfamethoxazole exposure: From two cohort studies (129 participants and 3 different antibiotic exposure groups) the
sulfamethoxazole 25027 in the odds of isolating trimethoprim-resistant bacteria immediately after exposure to trimethoprim/ sulfamethoxazole (OR 4.5, 95% CI 1.8–11.7; Fig. 7 in the Appendix).DiscussionOur systematic review found that antibiotic
trimethoprim 16402 [44], [46], [49], [50]], cephalosporin (8) [[31]–[33], [36]–[38], [49], [50]], sulphonamides and trimethoprim (2) [[42], [45]], quinolones (1) [[46]], lincomycin (1) [[43]] and ketolides (1) [[35]]. One study included
trimethoprim 18326 antibiotic exposure. -ve, negative, CI confidence interval, df degrees of freedom, SMX sulfamethoxazole, TMP trimethoprim Resistance in respiratory tract bacteriaBacteria were isolated from the respiratory tract in 19 studies
trimethoprim 23631 of isolating resistant Gram-negative bacteria was 3.2 (95% CI 0.9–10.8; Fig. 5).Trimethoprim and trimethoprim -sulfamethoxazole exposure: From two cohort studies (129 participants and 3 different antibiotic exposure
trimethoprim 24952 In gastrointestinal tract Enterobacteria, there was a significant increase in the odds of isolating trimethoprim -resistant bacteria immediately after exposure to trimethoprim/sulfamethoxazole (OR 4.5, 95% CI 1.8–11.7;
trimethoprim 25014 significant increase in the odds of isolating trimethoprim-resistant bacteria immediately after exposure to trimethoprim /sulfamethoxazole (OR 4.5, 95% CI 1.8–11.7; Fig. 7 in the Appendix).DiscussionOur systematic review
Select Disease Character Offset Disease Term Instance
pneumonia 1254 time-series studies (total 16,353 children and 1461 adults) were eligible.Resistance in Streptococcus pneumonia e initially increased fourfold after penicillin-class antibiotic exposure [odds ratio (OR) 4.2, 95% confidence
pneumonia 17653 controlled trialFig. 3Pooled odds ratios for resistance in respiratory tract bacteria (Streptococcus pneumonia e) and antibiotic exposure by class. Studies grouped by time from the end of antibiotic exposure. CI
pneumonia 18494 isolated from the respiratory tract in 19 studies and from the conjunctiva in one study.Streptococcus pneumonia e and penicillin exposurePenicillin-resistant Streptococcus pneumoniae were studied in only one controlled
pneumonia 18563 conjunctiva in one study.Streptococcus pneumoniae and penicillin exposurePenicillin-resistant Streptococcus pneumonia e were studied in only one controlled study (with 35 participants). Before exposure to penicillin, resistance
pneumonia 19883 amoxicillin exposure were short-lived, returning to normal by 1 month after the end of treatment (Fig. 3).S. pneumonia e and cephalosporin exposureThere were no RCTs. Four cohort studies (519 participants and 8 different
pneumonia 20178 exposure (OR 2.2, 95% CI 1.7–2.9), persisting after 1 month (OR 1.6, 95% CI 1.2–2.3; Fig. 3).S. pneumonia e and macrolide exposureThere were three controlled studies. After a month, one small study reported
pneumonia 24684 respiratory isolates, 3 months after azithromycin exposure, the OR of isolating clindamycin-resistant S. pneumonia e (OR 4, 95% CI 1.6–10.1) and erythromycin-resistant S. pneumoniae (OR 2.1, 95% CI 1.1–3.9) was significantly
pneumonia 24751 isolating clindamycin-resistant S. pneumoniae (OR 4, 95% CI 1.6–10.1) and erythromycin-resistant S. pneumonia e (OR 2.1, 95% CI 1.1–3.9) was significantly higher between exposed and unexposed groups. In gastrointestinal
pneumonia 25379 with any of the antibiotics studied. This generally decayed over the next month, particularly in S. pneumonia e isolates treated with penicillins. The effect of cephalosporins on resistance was less pronounced at
pneumonia 30179 to antibiotics may be faster than previously reported [[19]] for penicillins against respiratory S. pneumonia e, and perhaps H. influenzae, although this may not be true for other antibiotics such as macrolides,

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