Table 1 Correlation of antimicrobial resistance with antibiotic prescribing and/or volume of antibiotic use
From: Antimicrobial stewardship in rural and remote primary health care: a narrative review
Reference # | First author | Year | Study type | JBI checklist used (score/total) | Country | Setting/population | Main findings |
|---|---|---|---|---|---|---|---|
Rural and remote | |||||||
[25] | Doan | 2020 | Randomized controlled trial | Randomized controlled trial (11/13) | Niger | Children below 5 years of age from 30 villages | Genetic determinants of macrolide resistance were 7.4 times higher at 36 months and 7.5 times higher at 48 months in the azithromycin group compared to placebo. Mass azithromycin distribution also increased determinants of resistance to non-macrolide antibiotics, including 2.1 times higher beta-lactam resistance |
[29] | Hare | 2013 | Prospective cohort study | Cohort Study (10/11) | Australia and Alaska | Indigenous children in outpatient clinics or in hospitals | Azithromycin use was correlated in a ‘cumulative dose–response’ relationship with significantly increased carriage of S. pneumoniae and S. aureus strains resistant to macrolides. Carriage of S. aureus increased but carriage of S. pneumoniae, Haemophilus influenzae and Moraxella catarrhalis decreased with azithromycin use |
[23] | Jeong | 2020 | Retrospective database analysis | Prevalence Study (9/9) | Canada | 12 First Nations communities recruited in nursing stations | Skin and soft tissue infections due to community acquired MRSA were highly prevalent in remote, isolated Indigenous communities across Canada, as was use of antibiotics |
Urban | |||||||
[31] | Hoberman | 2016 | Randomized controlled trial | Randomized Controlled Trial (11/13) | United States | 520 children with acute otitis media | Antimicrobial treatment of shorter duration resulted in less favourable health outcomes compared to standard treatment, with no difference in rates of adverse events and antimicrobial resistance |
Mixed urban and rural | |||||||
[32] | Evans | 2019 | Systematic review | Systematic Review (7/11) | Multiple, including rural Australia | Predominantly children and young people with active trachoma | Communities treated with azithromycin had an approximately fivefold increased risk of resistance at 12 months of S. pneumoniae, S. aureus, and Escherichia coli to azithromycin, tetracycline, and clindamycin, but not to penicillin or trimethoprim-sulfamethoxazole |
[24] | Hansen | 2019 | Systematic review | Systematic Review (10/11) | Multiple, including rural Australia | Varied, both hospitals and primary care | Identification of bacteria resistant to macrolides were more frequent immediately after exposure, but resistance was inconsistent thereafter |
[30] | Hare | 2015 | Randomized controlled trial | Randomized Controlled Trial (11/13) | Australia and New Zealand | Indigenous Australian children living in remote regions and urban New Zealand Māori and Pacific Islander children | At 6 months post-intervention, macrolide resistance declined for S. pneumoniae but remained for S. aureus strains. Independent factors for macrolide resistance included azithromycin treatment, remote settings and poor adherence |