......................................................................................................... The European Journal of Public Health, Vol. 30, No. 2, 265–269 ß The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckz137 Advance Access published on 2 August 2019 ......................................................................................................... Impact of antibiotic consumption on the carriage of antibiotic-resistant bacteria by school children Maja Farkasˇ 1 , Tatjana C ˇ ulina 2,3 , Jadranka Sisˇul 4 , Gordana Pelcˇic´ 5,6 , Martina Mavrinac 7 , Vladimir Mic´ovic´ 8 , Arjana Tambic´ Andrasˇevic´ 9 1 Department of Microbiology, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia 2 Department of School and University Medicine, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia 3 Department of Family Medicine, University of Rijeka Faculty of Medicine, Rijeka, Croatia 4 Private Paediatric Practice, Rijeka, Croatia 5 Department of Paediatrics, Health Care Centre of Primorsko-Goranska County, Rijeka, Croatia 6 Department of Social Sciences and Humanities in Medicine, University of Rijeka Faculty of Medicine, Rijeka, Croatia 7 Department of Medical Informatics, University of Rijeka Faculty of Medicine, Rijeka, Croatia 8 Department of Environmental Health, University of Rijeka Faculty of Medicine, Rijeka, Croatia 9 Division of Bacteriology and Hospital Infections, Department of Clinical Microbiology, University Hospital for Infectious Diseases ‘Dr. Fran Mihaljevic´’, Zagreb, Croatia Correspondence: Maja Farkasˇ, Department of Microbiology, Teaching Institute of Public Health of Primorsko-Goranska County, Kresˇimirova 52a, 51000 Rijeka, Croatia, Tel:+385 51 358 761, Fax: +385 51 358 775, e-mail: maja.farkas@zzjzpgz.hr Background: Antibiotic consumption in the paediatric population is one of the key drivers of the emergence and spread of antimicrobial resistance, which is a serious global threat to public health and clinical medicine. The aims of this study were to investigate systemic antibiotic consumption in school children and to assess the associations among antibiotic consumption, carriage rate and resistance of respiratory pathogens residing in the upper re- spiratory tract mucosa. Methods: In this prospective study, throat and nasopharyngeal swabs from 450 school children, 6–15 years of age (225 healthy children and 225 patients who were ambulatory treated for upper re- spiratory tract infection), were processed in 2014 in Rijeka, Croatia, and clinical data were obtained via a ques- tionnaire. Results: In total, 17% of the children had consumed an antibiotic in the previous 6 months, including 7% of the healthy children and 27% of the acutely ill patients. The most commonly prescribed antibiotics were amoxicillin (26%), amoxicillin with clavulanic acid (26%) and macrolides (18%). Respiratory pathogens were more frequently isolated from children who had consumed an antibiotic in the previous 6 months [odds ratio (OR) 3.67, P < 0.001]. Antibiotic-resistant bacteria were also more frequent in children who had been exposed to antibiotics (OR 5.44, P < 0.001). Conclusions: Penicillins are the most frequently used antibiotics among school children. The results of this study demonstrate that antibiotic consumption is linked with higher carriage rates and resistance rates of respiratory tract pathogens. Therefore, rational use of antibiotics could prevent the emergence and spread of resistant bacteria. ......................................................................................................... Introduction A ntimicrobial resistance is a well-recognized global threat to public health and clinical medicine. 1,2 Antibiotic consumption is one of the key drivers of the emergence and spread of antimicro- bial resistance in community. Most antibiotics are prescribed in ambulatory care, and in Croatia, more than 90% of all antibiotics are prescribed in the outpatient setting. 2–4 In Europe, extreme dif- ferences in the prescribing of antibiotics and antimicrobial resistance rates have been recorded between northern countries and southern and eastern countries. Croatia belongs to a group of countries with high overall antibiotic consumption and consequently high anti- microbial resistance among bacteria that commonly cause infections in community. 3,5–7 The association between antibiotic consumption and bacterial resistance in primary care has been confirmed at both the individual and population levels. 6,8,9 Antibiotics are mainly prescribed for upper respiratory tract infections, which are often self-limiting and viral in origin. Broad- spectrum antibiotics are often inappropriately prescribed for these infections, causing significant financial burden and leading to the emergence and spread of bacterial resistance. 4,10–12 Antibiotics are the most commonly prescribed drugs for children, especially among the pre-school population. 10,12,13 School children are not affected as much as children in day-care centres and nurseries, as school children are less susceptible to infections than the children in these facilities. 13–15 However, school children may also serve as important reservoir of antibiotic-resistant bacteria in the community. The aims of this study were to investigate systemic antibiotic consumption by school children and to evaluate the associations among antibiotic consumption, carriage rate and resistance of re- spiratory pathogens residing in the upper respiratory tract mucosa. We analyzed the incidence and resistance patterns of the most common respiratory pathogens, namely, Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. Methods Study population All data on children enrolled in this prospective study were processed during the school year, from 29 January 2014 to 16 June 2014 and 22 September 2014 to 04 November 2014. Throat and nasopharyngeal samples were collected from 450 children between 6 and 15 years of age. Two groups of school children were included in the study, 225 healthy children with no signs or symptoms of respiratory tract infection in the previous 2 weeks and Antibiotic use and resistance in children 265 Downloaded from https://academic.oup.com/eurpub/article/30/2/265/5543077 by guest on 28 November 2022